USMLE STEP 1: COMMUNICATION (PATIENT-CENTERED) w/ Questions

[@Dr.Contra]

Thank you so much Doctor for the great explanation, i wanted to draw your attention to 20:06, where you chose Precontemplation over Contemplation because in FA it's written that Precontemplation is the "Denial stage" where the patient refuse to even acknowledge he/she has a problem while "Contemplation" the patient would admit having a problem but unwilling to change (like the case you presented). Thank you again doctor Neil and please let me know if i miss understood this point

[@RandyNeilMD]

I think your definition may be most accurate. For this particular problem I would feel pre-contemplative...but jmo. My take: Pre-contemplative - lack of awareness for change. Contemplative - "Initial consideration" for change. This guy doesn't have consideration imo

[@dramygdala8798]

@@RandyNeilMD Hi Dr Randy. Sorry to be bothering you about this after so many months of it being posted. So first aid says and i quote - ‘Precontemplation-denies problem and its consequences’ and ‘Contemplation-acknowledges problem but is ambivalent or unwilling to change’. Based on this, the answer would rightly be B in this case. Can you please let me know if this is wrong. Thanks a bunch!

[@hadayakhan3786]

@@dramygdala8798 I got confused at the same thing but the last line asks about Mr john desires to change lies at which stage. Not tell us that he desired to bring a change.

[@dsun_blue183]

Randy , best teacher in world ,,hats off

[@RandyNeilMD]

Thank you!!

[@hazazihazazi4204]

thank you so much Dr Randy. we are really freaking out about the step 1 changes please do more communication videos.

[@RandyNeilMD]

I'll see if I can dig up some new information...

[@mane6377]

Very helpful 👌 Was waiting for this More communication or any important new change videos would be great randy 🙂 And thanks hehe

[@princessz5087]

Amazing as always. One of the BEST channels of USMLE!

[@RandyNeilMD]

Princess Z, I am humbled... Thank you for leaving a comment.

[@martinogwuru614]

Really, I don't normally praise. Thank you so much for all your material. I really appreciate your contributions.

[@RandyNeilMD]

Martin, Thank you for taking time to comment. Much appreciated.

[@umerhayat6857]

Thank you so so much for this section in your library Dr. Neil!!!!. Honestly communications is something that appears out of the blue on step 1 when you’re thinking on the right approach to your answer. There are so many confusing possibilities to it!!. These videos like all other made it extra simple!!!. Amazing!!.

[@RandyNeilMD]

Thank you Umer... Appreciate the thoughtful comment.

[@rekmasah]

GOD BLESS YOU ...YOU R HERO FOR ALL OF US

[@RandyNeilMD]

Rekma, You are most welcome. I am glad video is helpful... KEEP STUDYING HARD!!

[@luislemus5144]

Taking my test in one month, first time I hear about this article. Awesome video, looking forward for another one.

[@RandyNeilMD]

Luis, I hope the video has been helpful.

[@anwarismail5177]

Dr. Neil you are so great at explaining so many great questions that trouble a lot of us! thank you for sharing your knowledge! stay blessed!

[@RandyNeilMD]

Anwar, Thank you for commenting. Glad it was helpful.

[@ashwinim7277]

Dr.Randy , you are so simplistic in everything , love that more than anything about you and your smile is great - oops love your pen and paper 😀 so glad you are back at making videos which are the highest rated- hope you are aware . I’m binge watching your videos today , exam next week , these are highest yield pearls. Thankyou so much 😀

[@RandyNeilMD]

Ashwini, I hope the exam went well... Keep me posted with your progress... Thank you for commenting,

[@ashwinim7277]

@@RandyNeilMD hello sir, yes I’m finally done with my exam -im in the upper mean , I’m so thankful to you . I see a lot of newer videos - a lot to catch up to you . I was lower on Behavioral sciences so I got to work a lot harder on that for ck and your videos are back at the right time 😀

[@Knstar5566]

Great explination, I always struggle with this topic but not any more, thank you 🙏

[@RandyNeilMD]

Musawair, Thank you as always.. I hope you are still studying HARD!!

[@happsingh477]

thank you sir for being so selfless and giving back, your video humble me beyond words

[@RandyNeilMD]

Happ, Thank you for taking time to comment. Keep me posted on your progress and what we can do to help...

[@happsingh477]

@@RandyNeilMD Thank you so kindly. Did you ever get my emails on some of the biostats questions (kinda went against what was said in one of your previous videos, maybe 1-2 more questions)

[@KristinaInKentucky]

Hi Dr. Neil! Thank you for taking the time to come up with this video. The announcement on changes to Step 1 were a little intimidating at first, but this certainly put my worries to ease.

[@RandyNeilMD]

Hungry IMG... Just another small hurdle in the journey...

[@flimsyflamingo2054]

Thanks Dr. Neil, very lucid explanations as always.

[@RandyNeilMD]

Hasnain, Thank you for the comment. Keep studying HARD!!

[@pawan_dk]

Thanks a lot Dr Randy... God bless you for this good work!

[@RandyNeilMD]

You are most welcome.

[@ahmedhelmy3173]

Hello Dr Neil, thank you so much for this video and others. They are so HELPFUL. If you do not mind, can you tell me the idea behind the black and white vodeos?

[@RandyNeilMD]

It's all about keeping it less distracting, very basic... It's not meant to overly engage through "bells and whistles", but to keep the focus on the information. The USMLE exam itself is done in a very basic computer, chair setting... I know if you can learn with me in a non-distracting environment, you'll be ready for the monotonous environment of the exam.

[@BeMihret5909]

Thankyou Dr! that is thoughtful of you.

[@RandyNeilMD]

Glad it was helpful

[@priyamano1393]

Sir thank yo so much for dis ,2weeks out for my step 1exam and this is gold. So grateful to yo✨😇 As always yo are amazing 🌟

[@RandyNeilMD]

Priya, HOME STRETCH... stay CONFIDENT... stay FOCUSED!!

[@Dr.SNY24-7]

Just wow! Such a nice person, teacher & MD you are, Sir Randy!

[@RandyNeilMD]

Shikh, Thank you for taking time to comment and kind words.

[@chetanreddycds]

Dr Randy thank you for the great video :)

[@RandyNeilMD]

Chetan, Thank you as always for the kind words. Keep studying HARD!!

[@jacobhernandez953]

thanks Dr Randy! very very helpful!!

[@RandyNeilMD]

You are most welcome. Glad it was helpful.

[@mandvipandey5247]

Was stressing out because of the content change, as my step is in 4 weeks. But this video is Savior. Thank you so much Dr. Neil.

[@RandyNeilMD]

Mandvi, Keep us posted on your progress. STUDY HARD!!

[@brandonvelazquez557]

Good luck!! Mine is in 6 weeks

[@obadashiti6221]

considering the last question, i think the answer "contemplation would be more accurate" Precontemplation stage: The individual denies or is unaware there is a problem. Contemplation stage: The individual is aware there is a problem but not willing to make a change

[@eozzan9143]

same!!

[@babygurll7]

I agree with you! This Transtheoretical model is sooo hard to learn because it seems that everyone has a different way of defining pre-contemplation/contemplation, it's so tricky.

[@sumayabuzakok1463]

❤simply I adore your way...thx alot ❤️

[@sheilachan100]

Dr. Randy, thanks so much for this awesome video!! im always looking for more practice, and your teaching style makes me feel like I have a personal tutor. Really like how you write/draw everything out! Taking step 2 in 2 weeks!!

[@RandyNeilMD]

Sheila, FINISH STRONG with your studies... You are getting CLOSER...!!

[@sheilachan100]

@@RandyNeilMD thank you Dr. Neil!! I really appreciate the encouragement!

[@mariuma2506]

thank you so much. you are a gem

[@RandyNeilMD]

Thank you Mariam.

[@vishweshpatel1997]

Thank you so much for what you do.

[@RandyNeilMD]

Appreciate the comment. You are most welcome.

[@bk1968]

thankyou for this! Didnt know where to go for this topic, these videos help

[@RandyNeilMD]

bk, Glad it was helpful.

[@sandhya797]

Hi Dr.Randy, I don't see you these days. How are you ?

[@dr.sankesh3170]

last question: in starting it said the patient knows about his behaviour and at the end it mentioned he desires to change. i think options A precontemplation and option B contemplation are conflicting with each other. can not tell apart between the two based on the question.

[@xaaboopinkly]

Huge thanks sir! Your videos are incredible! Appreciate your efforts..

[@RandyNeilMD]

Xaaboo, Thank you for commenting..as always. Keep studying HARD!!

[@thirstycrow10]

Awesome, nicely explained. Thanks a lot Sir!!!

[@RandyNeilMD]

Afaq, Thank you for commenting. You are welcome.

[@abhikhalder7351]

Errata:”Unwilling to change” also falls under contemplation along with”ambivalent” so last question answer will be contemplation.

[@sreegowthami8600]

Thanks a lot Dr. Since announcement regarding changes in communication I have been searching many resources regarding this but never found one... And finally u did this thank u once again Waiting to see many more videos in this aspect

[@RandyNeilMD]

Dr. Slokha, I'm glad you found it helpful. I appreciate your feedback.

[@sandhyajcp]

Thank you so much.....your videos are very very helpful :) God bless you.

[@RandyNeilMD]

Sandhyajcp, Thank you for commenting. Glad it was helpful.

[@eveyarzanova2127]

Thank you so much for making these videos!!!! Wondering if there is a pdf of the questions anywhere to annotate as we watch...??

[@RandyNeilMD]

It's a good idea to have those, but I don't have the "technical skills" to do it myself...(ie. put pdf's online) and I have to hire webguy...

[@sandhya797]

Dr.Randy, any song recommendation other than check mate

[@medico6060]

Thanks a lot !!❤

[@RandyNeilMD]

You are welcome

[@danieldonascimentoaraujo3221]

Amazing question!!1

[@RandyNeilMD]

Thanks Daniel

[@wiliam4294]

Thanks Dr. Neil

[@suhaabu-shamla9800]

Such a great content , thank you so much .

[@RandyNeilMD]

Soha, Glad it was helpful.

[@mehru2665]

Sir your videos are soo helpful. Could you please do one on autonomic nervous system pharmacology. Get so confused with this topic

[@RandyNeilMD]

Mehru, I'll see if I can come up with something.

[@nasrinqureshi808]

Very good explanation..

[@RandyNeilMD]

Thank you

[@usmleislife3396]

This is amazing...it’s really helpful

[@RandyNeilMD]

USMLE Goal, Glad it was helpful.

[@pottabathinirahul7609]

Great explanation sir. Please make more videos on ethics bcoz usmle is going to change from Oct 20.Thanks

[@RandyNeilMD]

Pottabathini, I'll look to see what we haven't covered in that topic. Thank you for commenting.

[@sjp6828]

Please help me understand what the best decision would be for diagnostic uncertainty, Doctor Neil. Say a patient gives birth and notices the nurses and doctor look concerned. She asks, "what is wrong with my baby?" Based on your knowledge, it appears the child has Down syndrome. Do you tell the mother that it appears they have DS and will do a test to confirm? Or do you just let the mother know that there are abnormalities and you will need to run tests to find a diagnosis? Thank you for your assistance! (Anyone else who has an answer may feel free to respond.)

[@RandyNeilMD]

Not sure as I am skewed between what I might say versus what the BOARDS would want you to do... Since I don't know with certainty...I'll have to defer on this one for now.

[@nadiapaul3455]

Can you please tell me if a doctor can attend a patient while caring her grandson?

[@ItsMe-tk4bi]

Hey Randy,according to FA pre-contemplation is not acknowledging that he has a problem, contemplation is knowing there is a problem but not willing/ready to change.Can you clarify

[@RandyNeilMD]

My take: Pre-contemplative - lack of awareness for change. Contemplative - "Initial consideration" for change. This guy doesn't have consideration imo The main part is to just be aware of the Question type...

[@brianbroadnax1509]

@@RandyNeilMD i had the same concern. "he knows he should do a better job" i took this to mean acknowledging that there is a problem. and "sorry doc old habits are hard to break"i took this to mean but not ready or willing to make a change. Now i'm confused. HELP PLEASE.

[@ItsMe-tk4bi]

@@brianbroadnax1509 I had the same thought

[@mandipkmann]

What pen do you use Dr. Neil?

[@RandyNeilMD]

0.7 mm... I like it.

[@intisar221]

Thank you so much . This is the same for CK ? To read ?

[@bushrasteps4335]

Once again thanku doc keep it up 👍

[@RandyNeilMD]

Bushra, You are most welcome.

[@doctorposting]

i saw another video with examples where the answer was NOT “how many i help you?” cause you’re basically sounding unsure of how to proceed to the patient. i was surprised it was the answer at 17:36 🧐🧐🧐

[@elizabethmikhail3034]

thank you for these videos ! very few channels include active question solving. these are so helpful !!

[@RandyNeilMD]

Elizabeth, Thank you for the thoughtful comment.

[@vijayduwadi998]

Dr Neil. I am your big fan. Pls help me with this question. If a patient comes to you with increased protein in his diet and asks for suggestions what more should he do, which phase is he in? Action or prep?.

[@gegechannel391]

I can't thank you enough 💞💞

[@RandyNeilMD]

Gehan, Glad it was helpful.

[@sangayongmu2962]

Thank you 🙏

[@RandyNeilMD]

Sangay, You are welcome. I hope you are still studying VERY HARD!!

[@sangayongmu2962]

Randy Neil, MD yes doctor Neil , thanks for asking!

[@drahmadaneeq5601]

According to first aid, contemplation is the right answer

[@umairshahjee2443]

Yeah i m also with contemplation

[@hmooda1311]

Yep, I’d go with that too

[@malhar2895]

Ya i agree.

[@applejacks7554]

Regarding the first question, how is a physician allowed to work outside of his scope of practice? Is that not illegal? Shouldn't everything a cardiologist explains be within the scope of cardiology?

[@putch8]

THANK YOU!

[@RandyNeilMD]

You are most welcome.

[@yehiasaleh5078]

Amazing as usual sir, can you share the paper PDF so I can print and make the best use of them!

[@RandyNeilMD]

Yehia, I'm working on getting them posted. I'm relying on someone else to do it... and it's taken much longer than I had hoped/planned...

[@riri23245]

thank u so much doc

[@RandyNeilMD]

Most welcome!

[@IanOechsle]

AAFP definitions: During the precontemplation stage, patients do not even consider changing. Smokers who are “in denial” may not see that the advice applies to them personally. During the contemplation stage, patients are ambivalent about changing. Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain. He seems ambivalent to "old habits" and is completely aware he "should do a better job". He believes the advice given by physicians applies to him, but lacks interest in doing anything about it. Based on these, I think contemplation may apply more closely imo. Sorry I just saw a lot of this on the threads and wanted to clear it up a bit for myself.

[@RandyNeilMD]

Thank you for sharing...

[@rohnegi]

wow.. Sir respect.

[@RandyNeilMD]

👍🏻

[@4444hash]

thank you

[@RandyNeilMD]

Welcome.

[@rawanluna9176]

I think the question about the stages, the answer was contemplation because the patient stated to the doctor that he knows he should do better but he can't.

[@pratikpradhan1352]

Thanks :)

[@RandyNeilMD]

You are most welcome.

[@annieversary89]

Hi Dr. Neil, I was hoping to ask for your expert input regarding a particularly tricky communications question on a real exam, that I haven't been able to find the answer to anywhere. Question stem summary: Veteran w/ history of depression (non-suicidal, no delirium/psychosis) admitted to hospital for respiratory illness. On discharge, patient is with physician as well as his family, when he states "the doctor said 'I'd never get better', but I beat the odds," which the physician did not say. What is next best statement? The 3 most viable answer choices were: 1) I'm sorry, but I didn't say that. 2) Is it possible that your illness made you remember things incorrectly? 3) What makes you think I said that? I was torn and went with 1, because 2 and 3 seemed accusatory/overly confrontational. I wasn't sure if the presence of patient's family in the room, combined with the knowingly false accusation + lack of mental status issues, made it appropriate to apologize but state the truth so the family knew the physician did not say that. Appreciate any advice, thank you so much!

[@RandyNeilMD]

Just based off of that...I'd go with the on that allows them to explain/clarify something that could be cleared up. Choice 3. On these types of questions, I'd always try and imagine I had Priest and the Hospital CEO next to me...and how that would influence my choice. It would remove the EGO from my response.

[@surajkaranje3916]

Isn't Pre Contemplation : Denies problem and its consequences (in this question , if he said i don't think having soda can rise Hb level) contemplation : He acknowledges problem bt unwilling to change ( he knows having soda is a problem bt he isnt willing to change) should be the answer preparation : planning for change ( he has searched online for susbstitue for soda or exercising videos)

[@zegy8454]

chikin >>> helth

[@backflipmania1]

Gorilla press from Randy savage

[@RandyNeilMD]

Let's Pile Drive the Step exam...

[@nomankhalid5814]

Marstro.

[@RandyNeilMD]

Noman, Thank you.

[@obadashiti6221]

considering the last question, i think the answer "contemplation would be more accurate" Precontemplation stage: The individual denies or is unaware there is a problem. Contemplation stage: The individual is aware there is a problem but not willing to make a change

[@spa1113]

agreed

[@ayeshasajid1833]

I was thinking the same

[@RuthLovesJesus]

Exactly! He’s aware, but hasn’t done anything to change

[@nanaagyeman8169]

It appears he is not ambivalent but committed, at least verbally, to make a change though

[@bronxbomma718]

IT can go either way. This patient has been told he has a condition but is in denial (read through denial in FIRST AID) and hence, PRECONTEMPLATION. With CONTEMPLATION, does it mean knowing issue and considering change OR knowing issue and not willing to make change. That is very subjective and not clear in how this question is written. That distinction will help you get this question right.