Patient needs addressed prior to and during history

Consider patients’ needs prior to and during information gathering.  Pressing issues (e.g., for treatment of serious injuries, crisis intervention and support, and childcare during the exam process) should be addressed before commencing with information gathering. Be mindful of patients’ capacity to answer questions during a lengthy information-gathering process, and take breaks as needed. 
 
The facility should have procedures in place and examiners should be educated to accommodate patients’ communication skill level and preferred mode of communicating. This is particularly important for patients with communication-related disabilities and non-English speaking patients. If interpreters are necessary, they should be present prior to questioning and there should be space for them in the exam room and rooms where information is gathered. Patients with communication disabilities may wish to use wordboards, speech synthesizers, or other assistive communication devices to help them communicate. The use of cards with pictures (e.g., of medical procedures and human anatomy) may facilitate communications with patients with some types of cognitive disabilities or limited vocabularies. [1]
 
It is important that examiners are aware of and responsive to verbal and nonverbal cues from patients. For example, patients may react negatively as they recall experiences during the assault or are reminded of previous violence committed upon them. (It is important to document this information.) What they may need most at this point is a break, the understanding of examiners, and opportunities to talk about what they are experiencing. Advocates can be particularly helpful to patients who are dealing with these emotions.  
 
Use a private and quiet setting for information gathering.  Ideally, there should be no interruptions and no time constraints for questioners or for use of the room where the information is being gathered. Although some facilities may lack space, an effort should be made to secure a private and quiet setting for this purpose. In many jurisdictions, history taking takes place in the exam room prior to the exam. 

[1] Paragraph partially drawn from N. Baladerian, Skills for Interviewing Adult Abuse Victims Who Have Developmental Disabilities, p. 1.


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