The Medical Interview: Communication Skills I - PowerPoint PPT Presentation

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The Medical Interview: Communication Skills I


Explain the purpose of each of the three basic functions of the interview. List the topics of an initial interview and written history. ... – PowerPoint PPT presentation

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Title: The Medical Interview: Communication Skills I

The Medical InterviewCommunication Skills I
  • Ted J. Ruback, M.S., PA-C
  • Associate Professor and Head
  • Division of Physician Assistant Education
  • Director, OHSU Physician Assistant Program

  • Describe the characteristics of positive regard
    for patients and how this leads to willingness to
    join patients as partners
  • Explain the purpose of each of the three basic
    functions of the interview.
  • List the topics of an initial interview and
    written history.
  • Describe how to greet and put a patient at ease.
    How to open, close, organize and guide the

Why a session on medical interviewing and patient
communication skills?
  • Evidence supports the importance of learning good
    patient communication skills. Research shows
  • 69 of interviews were interrupted by the
    physician within the first 18 seconds of the
  • 77 of the time, patients reason for coming to
    the physician were not fully elicited
  • When patients are asked to discuss their illness
    and treatment immediately after leaving their
    physicians office, they were able to correctly
    identify only about 50 of the critical

Objectives of the Medical Interview
  • Gather information
  • Establish rapport
  • Educate, support and motivate

Setting the stage
  • Create an environment designed to facilitate
    communication. What factors are important?
  • Atmosphere
  • Personal approach

Beginning the patient encounter
  • Review chart
  • Review identifying information
  • Note, record date/time
  • Knock on the door
  • Whats next?

  • Introduce yourself and explain your role
  • Address the patient appropriately
  • Express interest
  • Ask permission
  • How do you introduce yourself?

  • Subjective
  • Objective
  • Assessment
  • Plan

Subjective vs. Objective
  • Subjective
  • What a patient feels, describes indirectly with
  • Objective
  • Physiologic quantities observed directly

Subjective vs. Objective
  • True or False
  • Objective data is more important than subjective,
    because subjective data is lacking in

Subjective vs. Objective
  • FALSE!
  • Research suggests
  • 80 of diagnoses are made based on history
  • Physical exam adds another 10

  • Subjective
  • or
  • Objective?

The Complete Medical History
  • Identifying information
  • Chief complaint or concern (CC)
  • History of present illness (HPI)
  • Past medical history (PMH)
  • Family history (FH)
  • Social history (SH)
  • Review of systems (ROS)

The Complete Medical History
  • Identifying information
  • Often ignored
  • Name, age, gender, occupation
  • Source of referral
  • Source of history, reliability
  • PCP, nearest relative, contact information

The Complete Medical History
  • Chief Complaint or Concern (CC)
  • One of more symptoms or concerns for which the
    patient is seeking care or advice
  • Eliciting the chief complaint
  • Patients direct statement in response to an
    open-ended question, recorded accurately

The Complete Medical History
  • Documenting the Chief Complaint
  • The primary reason the patient is seeking medical
    attention, recorded using the patients own words,
    in quotes X duration
  • One sentence, never more than two
  • Do not editorialize or embellish
  • The chief complaint is not your interpretation of
    why a patient is seeking help, but the patients
  • The chief complaint is not a diagnosis

The Complete Medical History
  • History of Present Illness (HPI)
  • Description of the patients chief complaint
    starting from the last time the patient felt well
  • Attempt to understand the full story of the
    development and expression of the chief complaint
    in the context of the patients life
  • Determine the actual reason for coming in at this
    particular time

The Complete Medical History
  • Eliciting the HPI
  • The open-ended interview
  • Begin with open-ended questions
  • Move to more directed questions to clarify and
  • You need to know what information is needed and
    how to get it
  • You need to be able to evaluate the relevance of
    the information obtained

The History of Present Illness the seven
dimensions of a complaint
  • Location
  • Quality
  • Severity
  • Timing
  • Context
  • Modifying factors
  • Associated signs and symptoms
  • Risk factors

The History of Present Illness the seven
dimensions of a complaint
  • To help you remember - LOCATES
  • L ocation
  • O ther associated symptoms
  • C haracter (or quality)
  • A lleviating/aggravating
  • T iming
  • E nvironment/setting
  • S everity

The History of Present Illness the seven
dimensions of a complaint
  • To help you remember PQRSSTA
  • P rovocative/Palliative
  • Q uality
  • R egion
  • S everity
  • S etting
  • T iming
  • A ssociated symptoms
  • Mosby has two other suggestions

The Open-ended Interview
  • Goal is to guide the interview, not dominate it
  • Open ended questions to begin least control
  • More specific closed-ended questions as late in
    the interview as possible

The Open-ended Interview
  • When needed
  • Laundry list or multiple choice
  • Closed-ended, more direct, yes/no questions
  • Avoid at all times
  • Leading questions
  • Multiple questions
  • Yes/no questions for sensitive topics

Other suggestions for a successful interview
  • Pertinent negatives and positive symptoms
  • What does not occur in the course of an illness
    can be as important as what does 
  • Reminder in investigating pertinent negatives,
    avoid leading questions which encourage certain

Other suggestions for a successful interview
  • How the present illness has affected the patients
    quality of life is an important aspect of the
    HPI. The impact of the illness on
  • Interpersonal relationships
  • Work/school
  • Sexual relationships
  • Emotional stability
  • It is more productive to ask how rather than
    whether it has, in such instances

Other suggestions for a successful interview
  • Guiding the interview, encouraging communication
  • Facilitation
  • Reflection
  • Clarification
  • Empathetic response
  • Confrontation
  • Summary

Transition to the PE
  • Always give the patient the opportunity for the
    last word Is there anything else we havent
    covered that you would like to discuss before I
    examine you.
  • PE is a continuation of the interview process
  • Goals are same

Closing the interview
  • The closing interaction solidifies the
    relationship and sets the stage for managing the
  • Is there anything further youd like to tell me
    or ask me? unfinished business
  • Appropriate closure implies a contract

Closing the interview
  • Share findings physical findings, differential
    dx, your dx or hypothesis
  • Problem list and priorities
  • Negotiate a plan of action, clarify
  • Educate
  • Summation
  • Physical parting
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