HEADSS Up! 6 Topics you need to cover in your child / adolescent interview
Only 175 Days until the SPRING 2016 Family Medicine Certification Exam!
Are you registered for The Review Course?
I remember the first time someone told me that “children are not just little adults!” A constant stream of reminders about this followed me through residency when discussing UTIs and depression. What wasn’t so well taught were the nuances of doing a comprehensive interview when dealing with children.
Don’t worry –The Review Course is here to help.
In the following blog post we review the HEADSS mnemonic, a great tool to cover the areas required for any possible exam question that deals with children and adolescents. A full document is available online as well.
HEADSS will help you in 3 major areas:
It will help you gain a more comprehensive history about the patient’s presenting problem
It will help you gain valuable insight into the patient’s social history (crucial for the exam)
It will help you consider preventative health measures – a great way to provide full scope and comprehensive care.
Home and Environment – Open-ended questions are a great way to start this conversation. The age and era of the nuclear family is over, and for an oral exam, it’s a great way to trip up a candidate making too many assumptions about what a ‘normal’ family is. Any smokers in the house? Think broadly - Are there step-parents involved? Are both parents the same gender, perhaps?
Education and Employment –
How are your grades? Any favourite or most hated subjects at school? Any bullying (HOT TOPIC)? Do you have a part-time job? Are you making money in any other ways? What is happening with your money?
How much exercise are they getting daily/weekly? Any high risk activities that might require a helmet or supervision? Are they driving? – Be sure to recommend SEATBELTS!
ASK. It can be awkward even in practice to ask this question but don’t forget on the exam your “patient“ has been asked many times already that day – if they seem uncomfortable, they’re acting! Start by asking about smoking and then you can move into the other drugs to continue the flow of your interview. Or, you can ease in to it by saying, “When I was in high school, many people used drugs, does that happen at your school too?”
Are they in a relationship? Are they sexually active? Any high risk activities? Last HIV test? Are they concerned about pregnancy? And with any sexual history, be sure to ask: Do you sleep with men, women, or both?
If you are not comfortable asking questions about depression and suicide now…then you have 175 days until the exam to get comfortable doing so!
Forgetting about suicidality in an exam situation about depression is a red flag.
That being said, asking in an appropriate manner and at the right time is an art and not a science. You can try easing in to it: “On a scale of 1 to 10, where 10 is ‘life’s amazing’ and 1 is ‘life isn’t worth living,’ where would you rank your mood? Do you ever get to zero? or suicidal?” Start using all of your clinical encounters until the exam to rehearse - refine and think about this aspect of your practice.
PEARLS FOR PRACTICE
When you are in your own clinical practice and not covered with your residency program’s template statements, you will have to work out your own confidentiality statements that are appropriate for parents, children, and your EMR.
Taking the time to sit down and really think out, then verbalize, and finally write out your confidentiality statements into an EMR template or Word Document that can then be cut/pasted can be a big time saver and something the CMPA would be happy to see you doing!