Interviewing Techniques PDF

INTERVIEWING TECHNIQUES Dr Rokaia Ali Zain El-Abedeen Mohamed Toson Assistant Professor at Faculty of Allied Medical Sciences Aqaba University of Technology Communication Skills In Rehabilitation INTERVIEWING LECTURE (11) TECHNIQUES – Part (2)  Question  What should we kno...

INTERVIEWING TECHNIQUES Dr Rokaia Ali Zain El-Abedeen Mohamed Toson Assistant Professor at Faculty of Allied Medical Sciences Aqaba University of Technology Communication Skills In Rehabilitation INTERVIEWING LECTURE (11) TECHNIQUES – Part (2)  Question  What should we know about the patient interview – Part (2)? Interviewing Techniques The HCP-centered interview versus the patient-centered interview  Consider the following interview between a healthcare professional and their patient: HCP: “What brings you here today?” Patient: “I have chest pain.” HCP: “How severe is it?” “When does it occur?” “What do you do to relieve it?”  This is an example of the HCP-centered interview where the healthcare provider control the dialog. The stream of questions in response to the patients first complaint may, in fact, interrupt the patient. Interrupting the patient about the first complaint -which may not necessarily be the chief complaint- may prevent the patient from continuing to express all of their concerns. Interviewing Techniques  Contrast the previous interview with the following interview: HCP: “What brings you here today?” Patient: “I have chest pain.” HCP: “What else?” Patient: “I have been having a lot of trouble sleeping.” HCP: “Anything else?” Patient: “Well I have been very worried about my job. I am afraid that I may be laid off.”  This an example of the patient-centered interview where the HCP uses “continuers” expressions that encourage the patient to reveal all of their concerns at the beginning of the interview. The HCP allows the patient to tell their story and guides the patient to provide the important details by using both open-ended questions and indirect statements as well as specific closed questions. This approach provides the best information. Interviewing Techniques  The use of continuers also contributes to the development of a relationship between the HCP and their patient at the outset of their interaction. For example, the HCP may offer an expression of empathy and concern such as “You seem very worried.” or “You appear quite upset.”. This acknowledges the patient’s feelings and encourages the patient to reveal more information.  Finally, the patient-centered approach allows the HCP to be more attentive to the nonverbal messages expressed by the patient. The patient’s nonverbal behaviors, including eye contact, posture, and facial expressions, may provide important information regarding their physical and emotional state.  Interviewing Techniques Furthermore, The American Academy on physician and the patient suggests the use of “PEARLS” during the patient-centered interview, as it contributes to the relationship-building aspect of the medical interview. Partnership: conveys that the HCP and the patient are in this together. Empathy: expresses understanding and concern for the patient. Apology: acknowledge that the HCP is sorry that the patient had to wait, that the procedure was painful, that the lab tests will take several days to process, and so on. Respect: acknowledge the patient’s suffering, anxiety, fear, and so on. Legitimization: acknowledge that the patient may be angry, frustrated, depressed, and so on. Support: conveys that the HCP will be there for the patient and not abandon them. Interviewing Guidelines  Some important guidelines, strategies, and techniques that the HCP may employ to conduct a comfortable and effective interview.  Where appropriate, the rationale behind a given strategy and examples for implementation of the strategy are provided. 1. Call the patient by name. This will not only verify that you are interviewing the intended patient, but it will also begin to establish a connection between you and the patient. Refer to the patient formally. In other words, use “Mr.”, “Mrs.”, or “Ms.”. First names should be used only with the patient’s permission.  Interviewing Guidelines 2. Introduce yourself. Tell the patient about your role in this setting and clarify the reason for the interview. Explain the procedure (e.g., routine check up, ultrasound, electrocardiogram, pulmonary function test, cardiac stress test) and its purpose to the patient. 3. Show concern for the patient. A warm, caring facial expressions; honest, genuine responses; and empathy will help the patient to feel comfortable during the interview. The more comfortable the patient feels, the more forthcoming they will be when responding to your questions. 4. Convey an attitude of competence and professionalism. The proper attitude, as well as the proper attire, will help to put the patient at ease and help to establish the patient’s trust in you as a healthcare professional.  Interviewing Guidelines 5. Sit opposite the patient. The interviewer should sit approximately an arm’s length from the patient and maintain a relaxed but attentive posture. This arrangement will allow you to establish eye contact with the patient and to make visual observations for notation in the medical record. 6. Ask about the chief complaint first. This will provide an indication as to why the patient has come to seek medical attention.  Interviewing Guidelines 7. Perform a visual assessment of the patient. Make note of any observations, including: ▪ Physical and psychological distress of the patient. ▪ Posture and other nonverbal signals. ▪ Grooming. ▪ Coherence and clarity of expression. Body language often conveys a message of its own. For example, a patient who is upset physically or emotionally may not make eye contact with you or they may set with their arms crossed tightly. There may be times when the patient’s nonverbal communication conflicts with their verbal communication. In this instances, you may find it helpful to make this observation to the patient in an effort to draw them out and to encourage them to be more forthcoming.  Interviewing Guidelines 8. Be nonjudgmental. Never pass judgment or condemn a patient for their healthcare practices or beliefs. Negative feedback to a patient’s statement may inhibit further openness. The patient may now be less likely to reveal other important or relevant information. Positive feedback may cause the patient to lose focus and discuss topics that are not relevant to the chief complaint or the question at hand. 9. Use short probing questions. Speak slowly, clearly and distinctly. Direct questions will help to eliminate ambiguous responses or confusion on the part of the patient. A direct question is more likely result in a direct answer. “How often does this occur?” “Can you point to where it hurts?” “When did you notice that you were losing weight?”  Interviewing Guidelines 10. Use simple questions and statements that the patient will understand. You should use terminology that the patient will understand. A patient cannot provide accurate responses to questions they cannot comprehend. Example: “Describe the nature of your gastrointestinal distress.” Better: “Do you have nausea, vomiting, or diarrhea?” Example: “How long have you been experiencing amenorrhea?” Better: “When was your last period?” 11. Give the patient time to answer fully before going on the next questions. The patient needs to fully process the question and then determine how they really want to answer it.  Interviewing Guidelines 12. Listen attentively and respond with interest. This is perhaps one of the most important aspects of effective communication. Listening is not simply hearing words. It also involves being attentive to the way the words are actually said by the patient. In other words, the HCP must strive to understand the feelings underlying the spoken word. Interest may be established by making encouraging or prompting statements. “That’s quite interesting.” “Could you explain that more fully?” “And then what happens?” 13. Use continuers. It may help to draw out the patient and encourages them to elaborate. Examples of continuers include: “What else?” “Anything else?”  Interviewing Guidelines 14. Paraphrase important statements. Information recorded during the patient interview must be as accurate as possible. A helpful technique in achieving accuracy is repeating the information. Patient: “I get chest pains whenever I go up the stairs in my house” HCP: “Tell me if I have it right that you get chest pains whenever you exert yourself or exercise?” Patient: “I have been under a lot of stress, and I have been getting headaches all of the time” HCP: “Would it be correct to say that you have had a headache every day this week?” 15. Seek clarification. It is often helpful for the HCP to gently probe the patient and encourages them to offer further information. “I am not sure what you mean” I don’t think I fully understand what you are saying” In fact, at times it may be necessary to interrupt the patient. This will allow you to clarify important points and to slow down the interview process so that all relevant information can be accurately assessed and recorded.  Interviewing Guidelines 16. Verbalize the implied. Patients may not always express themselves directly. In this case, the HCP will have to infer, or drive a conclusion about, what the patient really means. To avoid potentially inaccurate interpretation of the patient's statement, you may encourage the patient to be specific by offering a follow-up statement or question. Patient: “My high blood pressure is probably due to my new boss” HCP: “Why is it due to your new boss?” Patient: “I have not been exercising” HCP: “Can you explain why not? How does exercising affect your asthma?” 17. Avoid getting off the subject. The interview should remain focused on the patient and their medical information. Wandering off onto another topic is inappropriate, unprofessional, and wastes valuable time. However, there may be instances where patients need to vent and express their feelings. Interviewing Guidelines 18. Introduce additional questions. The presence of some diseases such as HIV and hepatitis B may require the HCP to ask further questions of the patient regarding any history of illicit intravenous drug use and their sexual activity. All delicate subjects should be handled with the highest level of tact and delicacy. Once again, you should avoid being judgmental and should remain professional at all times. 19. Utilize the section for comments in the Medical History Forms. These forms often have a section for additional comments. This space may be used by the HCP to document any important information (e.g., race, ages, loss of a loved one, or other stress-inducing life events). Certain races, ages, and genders have a higher disposition of certain diseases or disorders. For example, hypertension, or high blood pressure, is more prevalent in blacks than in whites. Ear infection are more prevalent in children between 6 and 20 months of age than in children older than 6 years of age. Anemia, osteoporosis, and urinary tract infections are more prevalent in women than in men. Finally, the patient may not realize that personal information may be relevant and further explanation may be recorded here. Interviewing Guidelines Interviewing Guidelines 20. Immediately record the information. The HCP should Immediately record the patient information obtained during the interview. This will ensure an accurate and complete medical history and eliminate the need for you to rely on memory. 21. Summarize. A summary at the end of the interview allows the HCP to verify the accuracy and the completeness of the medical history. 22. Thank the patient. When the interview has come to a close, the HCP should provide the patient with an opportunity to ask any questions. This is followed with an explanation of the next step in the examination of procedure. Finally, thank the patient. Summary of Interviewing Guidelines Pinpointing the Chief Complaint or Present Illness  A primary goal of the interview is to identify the patient’s chief complaint. Questioning the patient during the interview should focus on, or pinpoint, specific symptoms or important medical information that will facilitate reaching an accurate diagnosis. This is accomplished by converting vague, general statements into clear, precise statements.  Quantified descriptions and statements are far more useful than those that are qualified. Example: “My knee has been hurting forever.” Pinpointed: “I have had mild pain in my knee for the past 2 months.” Example: “I always have headaches.” Pinpointed: “I have had three severe headaches this week.” Example: “My stomach never feels right.” Pinpointed: “I feel nauseous after I drink milk.”  Encourage the patient to pinpoint their symptoms promotes your understanding of the nature and the severity of the problem. Interviewing Children and Adolescents  There are many similarities between adult patient interviews and those of children and adolescents.  For example, the basic organization of the medical history and the professional guidelines for the interview are the same. Clearly, the demonstration of empathy and respect is equally important with all patients. However, there are also many differences between adult patient interview and those of children and adolescents. These differences are based upon the stage of physical, psychological, and emotional development of the patients as they progress from infants and toddlers to school-age children and, finally, to adolescents. Throughout these stages, the patient has increasing ability to contribute to their own story.  Interviewing Children and Adolescents Infants and toddlers: Although the patient is the focus of the interview, they are usually not a participant. The patient’s parent or guardian typically provides most of the information during the interview. However, it is helpful to have the child present to prompt the parent’s recall of relevant details. School-age children: Many children are able to contribute substantially to the patient interview by the age of 5 to 6 years. However, it is important to verify the accuracy of this information with the child’s parent or guardian. Interviewing Children and Adolescents Adolescents: As patients advance through their teenage years, they often begin taking increasing responsibility for their own health and health care while their parent’s roles begin to diminish. These changing roles may be awkward for both the patients and their parents. Assure the adolescents that your conversation is confidential. Information regarding drug and alcohol use, sexuality, and behavior and emotional issues should be obtained directly from the adolescent. Finally, it is helpful to avoid closed questions that tend to elicit brief responses and perhaps as a result, even silence. Legal Restrictions and Ethical Issues  The most important issue involved with obtaining and recording information is confidentiality, or the patient’s right to privacy. Face-to-face interviews are always conducted in private areas. Telephone interviews are always conducted with the utmost discretion. Medical information obtained in these interviews should not be discussed in the open office or elsewhere with family or friends or with other patients.  Violations of confidentiality damage the trust between the patient and the HCP. Furthermore, these violations open practitioners to lawsuits. Thank You