How do you take adequate collateral information in a patient?

Taking Adequate Collateral Information in Patients

To take adequate collateral information in a patient, clinicians should establish therapeutic alliances with both the patient and family members, use open-ended questions, gather information from multiple sources, and document important discussions in the medical record. 1

Key Sources of Collateral Information

• Establish who should be present for conversations and inquire about family members who cannot attend in person, considering options like teleconferencing for those unable to be physically present 1
• Gather information from family members and companions, who often ask more questions than patients themselves and provide valuable additional perspectives 1
• Access previous medical records, imaging studies, and electronic health records to ensure interpretations are made with complete availability of relevant collateral information 1
• Document the relationship of the informant to the patient, including their birthdate, gender, ethnicity/race, education level, and living status with respect to the patient 1

Effective Communication Techniques

• Use open-ended questions to encourage patients to share what is important to them, which has been shown to elicit more information than closed questions 1, 2
• Orient yourself to the patient's understanding and concerns by asking what they know and what they want to know 1
• Check for understanding by using "teach back" or "talk back" methods, with statements such as "In your own words, what does this mean to you?" 1
• Engage in reflective listening, make eye contact, maintain a calm demeanor, and be honest, genuine, and respectful 1

Family History and Health Information

• Obtain a thorough history of diseases in first-degree relatives, including past strokes, vascular disease, dementia, and other neurological diseases 1
• Compile a comprehensive health history including cardiovascular disease, cerebrovascular disease, medications, and other relevant medical conditions 1
• When interviewing adolescents alone, discuss the limits of patient confidentiality to facilitate an open and honest conversation 1
• Interview patients and caregivers both together and separately to gain comprehensive information 1

Documentation and Clinical Actions

• Document important discussions in the medical record, including the patient's understanding and preferences for information 1
• Research shows that reviewing more collateral sources is associated with an increased number of clinical actions following a clinical session 3
• Ensure that pathways of easy and prompt communication are well established between the interpreting clinician and referring providers 1
• When gathering collateral information, be careful not to alienate patients by relying too extensively on information from others 1

Cultural Considerations

• Actively consider cultural issues in diagnosis and treatment, as there are different standards of parenting and communication in different ethnic subgroups 1
• Be aware of the risks of approaching cases in a culturally insensitive fashion, which can undermine the therapeutic relationship 1
• Tailor language to the patient's educational level, recognizing that a patient may be intelligent and well-educated but still have low health literacy 1

Common Pitfalls to Avoid

• Avoid unnecessary delays in providing information to patients and their families 1
• Avoid information overload by providing information in small doses, stopping frequently, and checking for comprehension 1
• Be cautious about providing information when patients are emotional, as they often have difficulty absorbing and processing information in this state 1
• Avoid assuming that bad news interactions focus on one central piece of information; research shows that most interactions include multiple topics that require clear explanation 1