GUIDELINES FOR THE

STANDARDIZED PATIENT INSTRUCTOR INTERVIEW

Case scenario
You are rotating on a busy inpatient service. It is 10:00 AM and you have completed
morning work rounds on the 15 inpatients on your service. You have the next hour to
do most of the day's work (e.g., schedule diagnostic tests for your patients, prepare
for teaching or work rounds, write the daily orders for your patients).

Mr. or Ms. Gerhard is an 85-year-old patient who is to be discharged that morning.

Discharge orders were written last night, and the patient looked fine when you saw
him/her during your morning work rounds. The patient reported that they were
“ready to go.” However, a floor nurse has just informed you that Mr./Ms. Gerhard’s
daughter just called to say they cannot she bring the patient home. She didn't get
many details but reports that the patient's daughter said that she "couldn't handle
him/her" and that the patient would be “too much to take care of” at home. The
daughter is on jury duty and will not be available for you to call her until that
evening.

Your goal during this patient encounter is to learn what problems Mr./Ms. Gerhard
might have in functioning well at home. You set aside what you’re doing and enter
the room…
Assessing Patients’ Functional Status

A. ACTIVITIES OF DAILY LIVING and INSTRUMENTAL ACTIVITIES OF

DAILY LIVING
When asked how she is before beginning the interview she said that she was fine
and that was feeling good today. During the interview about the activities of her daily
living she shared that she still can-do bathing, dressing, toileting, grooming and feeding
alone. But she also said that her daughters are the one who are cooking her meals for her,
she stated “Kaya ko pa naman kumain mag isa pero ang nag luluto para saakin yung mga
anak ko.” She sometimes need help when transferring from chairs or when going to bed,
she said “Nakakatayo naman ako mag isa pero kailangan ko lang ng tulong minsan kasi
nga dun sa arthritis ko, mag walker pa nga ako minsan.” Regarding her aministration of
medication she said “Kaya ko naman inumin mga gamut ko pero ang mga bumibili ng
gamut para saakin yung mga anak ko.” When asked about grocery shopping, she said that
her daughters are the one who do it but she always come with them during grocery
shopping. When asked about her finances, she said “Yung mga anak ko ang gumagastos
sap ag papahospital ko, mga check-up at mga gamot. Pero yung pension ko ako parin ang
humahawak.” Her daughters are the one who do the laundry but she said that sometimes
she is helping them when she can. And regarding the housekeeping she said “Yung mga
madadali lang na gawaing bahay ang ginagawa ko bawal rin kasi ako mapagod ng sobra.”
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B. GAIT IMPAIRMENT (TIME UP AND GO)
When asked if she ever fallen for the past years, she said “Hindi naman,
nahihirapan lang ako tumayo minsan dahil nga sa arthritis ko yun lang.” During the
time up and go test, the client was instructed to rise up from the chair and walk to the
10 feet line on the floor, turn, return to chair and sit down again. She accomplished
the maneuver within 17 seconds and when asked how she felt about the task she said
“Okay lang naman hindi naman ako nahirapan o ano.”

C. COGNITION (MINI- COG)

Regarding her cognition, I first then asked if she is already having a hard time
remembering things and she said “Oo ah minsan dahil na rin sa tanda ko, pero kapag
may sinabi ka naman na importante saakin yun naman hindi ko mabilis makalimutan
pero minsan kailangan rin nila ipaalala mga sinabi nila.” The client was instructed
carefully to listen to the 3 things or word that I will be going to say to her, the words
were: phone, blanket and milk. After that she repeated the 3 objects that I said to her.
After that, I instructed her to draw a clock and draw the hands of the clock at 11:35,
she accomplished the task perfectly with the numbers indicated around the clock and
the clock hands at 11:35. After that, I asked her to repeat the 3 words again she got the
word phone and milk correct but she had a hard time remembering the word blanket
and does not got it correctly. Overall, in the mini-cog test she scored 2 with normal
CDT and that indicates absence of dementia.
D. AFFECT (DEPRESSION)
When asked how does she feel for the past few months she said “okay lang naman
ako yun nga lang napapagod rin dahil sa mga check- up ganun.” When asked if she has
been bothered by being depressed, feeling down and feeling of hopelessness she said
“Kahit na may sakit ako yan ang iniiwasan ko, lagi ako nag dadasal kay Lord at kay
mama Mary na kung pwede eh mabuhay pa ako ng matagal pero alam ko naman na
dadating din naman tayo lahat sa oras na yun pero okay lang saakin kasi nakapag tapos ko
naman na ang mga anak ko at malapit na rin grumaduate yung isa kong apo yun nga lang
gusto ko pa makitang lumaki yung mga iba kong apo.” During the past few months, she
said that her interest and pleasure in doing things does not decline, she stated “Hindi
naman gusto ko parin naman mga ginagawa ko, magtiklop ganyan tapos mag tahi tahi.
Yung mga anak ko nga binilhan ako ng maliit na makina pang libangan ko lang. Tapos
pag hapon nanonood ng teleserye ganun.”