10 Interviewing Techniques - Part 1 - Lecture (10) PDF

INTERVIEWING TECHNIQUES Dr. Sara Said Youssef Ali Assistant Professor at Faculty of Allied Medical Sciences Aqaba University of Technology Communication Skills In Rehabilitation INTERVIEWING LECTURE (10) TECHNIQUES (Part 1)  Question  What should we know abou...

INTERVIEWING TECHNIQUES Dr. Sara Said Youssef Ali Assistant Professor at Faculty of Allied Medical Sciences Aqaba University of Technology Communication Skills In Rehabilitation INTERVIEWING LECTURE (10) TECHNIQUES (Part 1)  Question  What should we know about the patient interview?  Interviewing Techniques  An Important and fundamental step in providing medical care is the patient interview. To properly diagnose the patient's condition and to develop the appropriate treatment plan, the healthcare professional (HCP) needs to obtain a thorough and accurate medical history from the patient.  There are three primary functions of the medical interview: Information gathering. Relationship building. Patient education. Interviewing Techniques The interviewee  The patient is typically the primary source of medical information; for this reason, the HCP will interview the patient directly. However, there are also instances in which the patient may be unable to provide their medical history directly to the practitioner.  Patients who are critically ill or even unconscious, mentally impaired, or very young cannot effectively communicate with their caregivers. In these cases, other sources are necessary to provide the required medical information. Family members, including parents of small children and adult children of seriously ill or disoriented parents, as well as spouses and significant others, now become the primary interviewees. Finally, other healthcare team members and the medical record are excellent sources of accurate medical information regarding the patient in question. Interviewing Techniques  The concept of family interviewing warrants further discussion for several reasons: ▪ Family members frequently accompany patients to the office visits and may serve one or more important roles. ▪ Families are the primary context within which most health problems and illnesses occur. ▪ The family has a powerful influence on health and illness as most health beliefs and behaviors (e.g., diet, exercise, smoking, alcohol, and drug use) are developed and maintained within the family. Interviewing Techniques  Family members often accompany patients to the doctor’s office, the emergency room, or other clinical setting. Although some family members remain in the waiting room, many come with the patient into the examination room.  This occurs most frequently when the patient is a child younger than 13 years or is elderly. Sicker patients are also more likely to have family companions at their visit. Interestingly, office visits that involve other family members typically last just a few minutes longer than other visits.  Interviewing Techniques  The presence of family members during the visit may offer many significant benefits during the medical interview. For example, the visit may be more efficient and cost-effective because the family members can provide important information about the health problem. Furthermore, family members may: ▪ Help communicate the patient’s concerns to the HCP. ▪ Improve the HCP’s understanding of the patient’s problem. ▪ Improve the patient’s understanding of the diagnosis and treatment. ▪ Help the patient to remember clinical information and recommendations. ▪ Express concerns regarding the patient. ▪ Assist the patient in making decisions.  Each of these functions serves to significantly enhance the communication and understanding between the HCP and their patient. Interviewing Techniques The setting  The interview between the HCP and patient may take place face-to-face in the doctor's office or in a hospital or clinic. The patient interview may also take place on the telephone. These different settings have a significant influence on the way interviews are conducted.  When a patient comes to the doctor’s office or to a department in the hospital, they should be escorted to an area that is both private and comfortable, usually the examination room. In this way, patient confidentiality is maintained. In face-to-face interview, you are able to observe any nonverbal behavior exhibited by the patient. Important information such as posture, willingness to make eye contact, and physical or psychological distress may be obtained by closely observing the patient. These observations, which may be helpful in diagnosing the patient or in developing the treatment plan, should then be noted on the medical history form. Interviewing Techniques  When conducting the interview on the telephone, the HCP may find it helpful to imagine that the interviewer and the interviewee are sitting back-to-back instead of face- to-face. In this case, the HCP is unable to observe the patient’s facial expression, cannot make eye contact with the patient, and is unable to receive any other visual feedback, such as body language.  Instead, the practitioner conducting the interview relies on the patient’s tone, pacing of speech, and word selection to interpret their condition and attitude. It is important to note that the patient will also draw conclusions regarding the interviewer based on these factors. Interviewing Techniques  Care must be taken to avoid misinterpretation of any kind. A cold, aloof, overly formal telephone voice will likely to fell put-off or as if they are bothering the medical staff. A warm, welcoming telephone voice is most likely to put the patient at ease and make them feel more comfortable during the course of the interview.  Finally, the interview will proceed more smoothly if the HCP concentrates on enunciating, or carefully pronouncing, their work and on being understood by the patient. It will be very frustrating for the patient if they are repeatedly asking or saying: “What?” or “Can you repeat that?” or “I can’t understand you”  Interviewing Techniques Types of questions  There are two types of questions that the HCP will ask the patient during the interview: closed (direct) questions and open-ended questions. Closed questions are designed to elicit short, focused responses such as a simple yes or no. These questions actually limit the information sought from the patient. However, the Detailed Report of Medical History Form consists predominantly of this type of question. “Have you ever had rheumatic fever?” “Have you ever had jaundice or hepatitis?” “Do you use tobacco?”  Interviewing Techniques  Other examples of closed questions that the HCP may ask the patient during an interview include the following: “Do you feel nauseous now?” “Where does it hurt?” “Did you have a fever this morning?” “You said that you have had high blood pressure Are you available for ultrasound on Thursday?  Closed questions quickly provide a great deal of objective information about the patient.  The HCP will often have only 15 minutes with the patient, and these questions will allow for the most efficient communication. Interviewing Techniques Interviewing Techniques Interviewing Techniques  Conversely, much important information, both objective and subjective, regarding the current physical and emotional conditions of the patient can be obtained only by way of open-ended questions. These questions often begin with who, what, where, when, how, and why.  As such, open-ended questions cannot be answered simply and require more discussion regarding a given health issue. These are the questions that helped to establish therapeutic communication and relationship between the patient and the HCP. The patient is required to provide more explanation when responding to these questions. Furthermore, the HCP has opportunity to paraphrase the patient's response and emphasize with the patient.  Interviewing Techniques  Open-ended questions often begin with how or what.  Examples of these questions include the following: “How are your stress levels at work?” “How has the new medication affected your sleep?” “What is this pain feel like?” “What conditions bring on an attack of angina?” “What did the doctor tell you about taking these medications?”  Open-ended statements may also be useful: “Describe when this occurs.” “Give me an example.”  Interviewing Techniques  The use of questions beginning with why should be used with caution. Consider the following questions : “Why don’t you take your medication?” “Why did you do that”  There may be no one true answer to a why question, as a patient’s motivation is often complex. In addition, these questions may be perceived as confrontational. The patient may feel as though they have to defend themselves, and this is likely to inhibit further communication and damage the therapeutic relationship between the practitioner and the patient.  Interviewing Techniques  On the other hand, there are times when why questions are useful.  For example, to engage in true collaborative decision making, it is necessary for the HCP to know what motivates the patient. The HCP will often need to ask the patient about the factors that might influence their ability to follow a certain treatment regimen. “Why are you concerned about taking this medication?” “Why are you worried about beginning this diet?” “Why do you think that is?”  In these situations, the questions are meant to improve the HCP’s understanding of how the patient feels about the given issue. Better understanding between the HCP and the patient often leads to enhanced patient compliance and improved health outcomes.  Interviewing Techniques  The use of leading questions and statements should be avoided. Such questions could include: “You haven’t had heart palpitations. have you?” “I assume you have shortness of breath.”  These types of questions or statements are likely to prompt or encourage the patient to provide what they perceive is the desired answer. If the patient does not fully understand the content of the question, they may be compelled to simply go along with the HCP to avoid appearing disagreeable. These responses may, in fact, be inaccurate and have a negative impact on the medical interview.  Interviewing Techniques  Another technique that may be employed during the patient interview involves the use of indirect statements: As with the open-ended questions, these types of statements help to establish therapeutic communication and a relationship between the practitioner and the patient. An additional advantage to such statements involves obtaining information from the patient without the patient feeling questioned.  Examples of indirect statements include the following: “Tell me about the diet you are on?” “That must be very difficult for you?” “Tell me how the new job is going?”  Interviewing Techniques  In addition to the section including “yes” or “no” questions, the Detailed of Medical History Also has section where explanations to various questions may be noted.  Examples of these questions include the following: “Have you ever been a patient in any type of hospital?” (If yes, specify when, where, why, and name of doctor and complete address of the hospital.)” “Have you ever been Denied life insurance? (If yes, state the reason and give details.)”  Finally, there is a section in the Detailed Report of Medical History for summary and elaboration of all pertinent data. Thank You