What is the recommended intake process for a new patient in a family medicine clinic?

Comprehensive New Patient Intake Process for Family Medicine Clinic

The recommended intake process for a new patient in a family medicine clinic should include a systematic assessment of the patient's medical history, family context, and psychosocial factors, with documentation of demographic data, establishment of rapport, and development of a collaborative treatment plan.

Initial Contact and Preparation

• Before the appointment:

  • Review any available medical information about the patient
  • Establish goals for the conversation
  • Arrange for an appropriate location with adequate time for discussion 1
  • Prepare demographic family history forms to gather data on family structure, psychiatric disorders, and family development 1

• During telephone intake:

  • Document family demographic data including family moves, changes in composition, socioeconomic circumstances, family illness, legal difficulties, and altered family structure 1
  • Explain why all family members should attend if appropriate for the case 1

Beginning the Visit

1. Introduction and rapport building:

   • Introduce yourself and your role in the patient's care
   • Sit down, make eye contact, and maintain a calm demeanor
   • Get to know the patient as a person, including their life before any health issues 1
   • Use an informal interview style to establish rapport by identifying family strengths and resources 1

2. Agenda setting:

   • Use open-ended questions to encourage patients to share what's important to them
   • Collaboratively set an agenda after inquiring what the patient/family wishes to address 1
   • Explain what you as the clinician wish to address

Comprehensive Assessment Components

Medical Assessment

1. Complete medical history:

   • History of present illness
   • Past medical history
   • Psychiatric review of systems
   • Assessment of sleep abnormalities
   • Pain assessment
   • Drug and food allergies
   • Review of immunizations
   • Medication reconciliation 1

2. Physical examination:

   • Focus on relevant systems based on patient's complaints
   • Include periodontal, thyroid, heart, breast, and pelvic examinations as appropriate 1
   • Use physical examination to both gather diagnostic information and develop therapeutic relationship 2

3. Laboratory testing:

   • Complete blood count, urinalysis, blood type and screen
   • When indicated: screening for infectious diseases, diabetes, and cervical cytology 1

Family and Social Context Assessment

1. Family structure and functioning:

   • Document family structure using a genogram 1
   • Assess family's communication patterns, belief systems, and regulatory functioning 1
   • Evaluate the effects of the patient's condition on family and vice versa 1

2. Psychosocial assessment:

   • Screen for depression, anxiety, domestic violence, and major psychosocial stressors 1
   • Assess substance use with standardized tools like CAGE or T-ACE questionnaires 1
   • Evaluate social determinants of health

3. Risk assessment:

   • Identify family risk factors for specific disorders 1
   • Assess reproductive life plan for women of childbearing age 1
   • Screen for genetic disorders based on family history, ethnic background, and age 1

Communication Strategies

• Adapt teaching to the patient's level of readiness, past experience, culture, and understanding 1
• Use simple language tailored to the patient's educational level 1
• For patients with low health literacy, focus on the most important points and check frequently for understanding 1
• For families who do not share a common language, use a medical interpreter rather than a family interpreter 1
• After providing information, check for patient understanding 1

Treatment Planning and Follow-up

1. Collaborative goal setting:

   • Involve patients in setting treatment goals and plans 1
   • Discuss treatment plans in terms of specific behaviors 1
   • Assess the patient's ability to carry out treatment plans and identify barriers 1

2. Health promotion:

   • Determine patient's health-risk behaviors through interview and health-risk appraisals
   • Introduce health-promotion topics during "teachable moments"
   • Provide specific suggestions for behavior change 1

3. Documentation:

   • Document important discussions in the medical record 1
   • Document educational efforts in specific terms 1
   • Include a plan for follow-up care

Common Pitfalls to Avoid

1. Rushing through the initial assessment:

   • The first visit establishes the foundation for the doctor-patient relationship
   • Allow adequate time for comprehensive assessment

2. Focusing only on medical issues:

   • Family medicine requires understanding the patient in their family and social context 3
   • Neglecting psychosocial factors can lead to incomplete care plans

3. Failing to check patient understanding:

   • Patients often leave appointments without fully understanding their care plan
   • Have patients restate the treatment plan to confirm understanding 1

4. Ignoring cultural differences:

   • Cultural differences affect health beliefs and patient education must account for these differences 1
   • Enter encounters with curiosity, aware that patients may have beliefs and expectations different from the clinician's 1

5. Not addressing cost concerns:

   • Explore whether cost of care is a concern for patients 1
   • Financial constraints may affect adherence to treatment plans

By following this structured approach to new patient intake in family medicine, clinicians can establish a strong foundation for ongoing care that addresses the patient's physical, emotional, and social needs in the context of family and community.