MASTERING THE ART
• Studies have shown that good communication improves health outcomes
by resolving symptoms and reducing patients’ psychological distress and
anxiety
MALPRACTICE
• In the United States, 85% of all
malpractice lawsuits are based on poor
communication skills
• It is not that the doctor didn’t know
enough; the doctor did not
communicate well enough with his/her
patient
MAIN PURPOSE
• The main purpose of an interview is to gather all basic information pertinent
to the patient’s illness and the patient’s adaption to illness
• The interviewer should be aware also of the influence of social, economic, and
cultural factors in shaping the nature of the patient’s problems
ACTIVE LISTENING
• Active listening continues to be central to the
doctor-patient interaction
• Active listening takes practice and involves
awareness of what is being said in addition to
body language and other nonverbal clues
THE ART OF LISTENING – SIMON SINEK
“Listening is not the act of hearing the words spoken, it is the
art of understanding the meaning behind those words. When
people say you are not listening to me, and we simply
powered back to them the words that the people said,
congratulations, your ears work. That is the act of listening.
With the art of listening, it is creating an environment in which
the other person feels heard. Now you noticed what I said
there, the other person (I used an emotional word) feels
heard. I don’t want to know that you heard the words, I want
to feel heard. I want to feel seen. I want to feel understood.
That is a learnable, practicable skill.”
INTERVIEW SUCCESS
• The success of any interview depends on its being patient-centered and not
doctor-centered
• In the words of Sir William Osler (1893), “Listen to your patient. He is telling you
the diagnosis…The good physician treats the disease; the great physician treats
the patient who has the disease.”
LANGUAGE
• For any patient who speaks a language other than that of the health care
provider, it is important to seek the help of a trained medical interpreter.
• Unless fluent in the patient’s language and culture, the health care provider
should always use an interpreter.
• Talk with the interpreter beforehand to establish an approach
• When speaking to the patient, watch the patient, not the interpreter
• Use clear, short, and simple questions
• When a family member is the interpreter, the patient may be reluctant to
provide information about sensitive issues, such as sexual history or substance
abuse.
• On occasion, the patient may request that a family member be the interpreter.
In such a case, clinicians should respect the patient’s wishes.
INTERRUPTION
• Several studies have shown that clinicians commonly do not listen
adequately to their patients.
• One study showed that clinicians interrupt the patient within the first 15 seconds
of the interview
MORALS
• Do not contradict or impose your own moral standards on the patient
• Knowledge of the patient’s social and economic background will make the
interview progress more smoothly
APPEARANCE
• The interviewer’s appearance can
influence the success of the interview
• Patients have an image of clinicians
• Surveys of patients indicate that patients
prefer medical personnel to dress in white
coats and wear shoes instead of sneakers or
sandals
PARALANGUAGE
• Speech patterns, referred to as paralanguage components are relevant to
the interview
• By manipulating the intonation, rate, emphasis, and volume of speech, both the
interviewer and the patient can convey significant emotional meaning through
their dialogue.
BODY LANGUAGE
• Body language, technically known as
kinesics, is a significant aspect of modern
communication and relationships.
• The sending and receiving of body
language signals happens on both
conscious and unconscious levels
• Generally, a genuine smile is symmetrical
and produces creases around the eyes
and mouth, whereas a fake smile tends to
be a mouth-only gesture
TOUCH
• Touch can communicate warmth,
affection, caring, and understanding
• Many factors, including gender and
cultural background, as well as the
location of touch, influence the
response to touch
• Appropriate placement of a hand on a
patient’s shoulder suggests support
• Never place a hand on a patient’s leg
or thigh, because this is a threatening
touch
DEPERSONALIZATION
• Health care providers may spend more time
looking at a computer screen than looking at
their patient
• A patient admitted to the hospital is stripped of
clothes and often dentures, glasses, hearing
aids, and other personal belongings
• A name tag is placed on the patient’s wrist,
and he or she becomes “the patient in 9W310”
• Inexperienced interviewers not only must learn
about the patient’s problems but also must gain
insight into their own feelings, attitudes, and
vulnerabilities
DETERIORATION IN COMMUNICATION
• As mentioned previously, most malpractice litigation is the result of a
deterioration in communication and of patient dissatisfaction rather than of
true medical negligence
• From the patient’s point of view, the most serious barriers to a good relationship
include the following:
•
•
•
•
•
The clinician’s lack of time
Seeming lack of concern for the patient’s problem
Inability to be reached
Attitude of superiority, arrogance, or indifference
Failure to inform the patient adequately about his or her illness
•-No popped collar
Gather yourself
•-Name badge
facing forward
•-Opened to the
correct piece of
paper
•-Emotionally
prepare yourself
SALIB’S
STEPS
Knock on door prior to
entering the patient’s room
[Pause and wait for answer]
Greeting
GREETING
• Good morning, are you Betty Smith? [Pause and wait for answer.]
• I am Allison Salib, a 3rd year medical student at Lake Erie College of
Osteopathic Medicine.
• I have been asked to interview and examine you this morning, is that okay
with you? [Pause and wait for answer.]
• Thank you! Before we get started, how would you like to be addressed?
• It is a pleasure to meet you Betty.
• Would you mind if I take a seat? [Pause and wait for answer.]
• I read in your chart that you were having _(chest pain)_ is that what brought
you to the hospital?
KEY INTERVIEW POINTS
• Avoid using the term “student doctor.” Identify yourself with your correct
level of education.
• Setting – allow privacy, offer them the opportunity to finish eating their meal,
etc.
• Visitors – introduce yourself and never assume the person’s relationship.
Always ask the patient if they are okay with proceeding with the interview in
the presence of their guest. Just because the patient has a visitor, does not
necessarily mean the patient wants the visitor to know all of their personal
health concerns.
KEY INTERVIEW POINTS
CONTINUED
• Sitting down while speaking conveys the unspoken understanding that the
interviewer is not in a rush and has time to spend with the patient
• Distance from patient to provider should be around 3 to 4 feet
• It is poor form to write extensive notes during the interview as your attention
should always be on the patient
• Never compound questions. For example, do you have X, Y, and/or Z? Do
you have X? Y? Z?
• If a patient asks for an opinion, it is prudent to answer, “Currently, I am a 3rd
year medical student. I will make sure we address this question and/or
concern when I return with my attending.”
• Conclude interview with a brief summary and then ask if there are any other
questions or concerns they wanted addressed today
MORTALITY
• Once patients recognize that they are ill and possibly face their own
mortality, a series of emotional reactions occurs, including anxiety, fear,
depression, denial, projection, regression, anger, frustration, withdrawal, and
an exaggeration of symptoms.
• Patients must learn to cope not only with the symptoms of the illness but also
with how life is altered by the illness
RESPONSES TO ILLNESS
• Conflict
• Anxiety
• Depression
• Denial
• Projection
RESPONSES TO THE INTERVIEWER
The Silent Patient
The Aggressive Patient
The Overtalkative Patient
The Help-Rejecting Patient
The Seductive Patient
The Demanding Patient
The Angry Patient
The Compulsive Patient
The Paranoid Patient
The Dependent Patient
The Insatiable Patient
The Masochistic Patient
The Integrating Patient
The Borderline Patient
A useful technique includes naming the emotion
VitalTips App
INFLUENCE OF THE BACKGROUND
AND AGE ON PATIENT RESPONSE
• The Child Who is Ill
• The Aged Patient
• The Widowed Patient
• The Patient with Posttraumatic Stress Disorder
THE SICK PHYSICIAN
• Every medical or nursing student goes through the “student syndrome,”
which is the suspicion that he or she has been stricken with the disease about
which he or she is learning.
• Imagine the anxiety that occurs when the physician actually is stricken.
INFLUENCE OF DISEASE ON
PATIENT RESPONSE
• The Disabled Patient
• The Patient with Cancer
• The Patient with Acquired Immune Deficiency Syndrome
• The Dysphasic Patient
• The Psychotic Patient
• The Demented or Delirious Patient
• The Acutely Ill Patient
• A careful history of the present and past illness must be taken expeditiously so
that the diagnosis may be made and treatment begun.
INFLUENCE OF DISEASE ON
PATIENT RESPONSE CONTINUED
• The Surgical Patient
• The Alcoholic Patient
• The Psychosomatic Patient
• The Dying Patient
• JPSM April 2022 Vol 63 No. 4 – What is a Good Death? A Choice Experiment on
Care Indicators for Patient at End of Life (13 Indicators)
• Health care providers’ ability to control patients’ pain to desired levels 11.5%
• Clean, safe, and comfortable facilities 10.0%
• Kind and sympathetic health care providers 9.8%