Introducción

Some important guidelines, strategies, and techniques that the HCP may employ to conduct a comfortable and effective interview are out-lined in this section. Where appropriate, the rationale behind a given strategy and examples for implementation of the strategy are provided.

Examples of Report of Medical History Forms are found in Figures 5-1 and 5-2.

1 Call the patient by name. This will not only verify that you are inter-viewing the intended patient, but it will also begin to establish a con-nection between you and the patient. Refer to the patient formally. In

FIGURE 5-3. Greet the Patient and Introduce Yourself.

other words, use “Mr.,” “Mrs.,” or “Ms.” First names should be used only with the patient’s permission.

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 func-tion test, cardiac stress test) and its purpose to the patient.

3 Show concern for the patient. A warm, caring facial expression; hon-est, genuine responses; and empathy will help the patient to feel com-fortable during the interview. The more comcom-fortable 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.

5 Sit opposite the patient. The interviewer should sit approximately an arm’s length from the patient and maintain a relaxed but atten-tive posture. This arrangement will allow you to establish eye con-tact with the patient and to make visual observations for notation in the medical record. Eye contact is an important aspect in establish-ing a connection between the interviewer and the interviewee.

6 Ask about the chief complaint first. This will provide an indication as to why the patient has come to seek medical attention.

“How have you been feeling since your last office visit?”

“What seems to be the problem?”

“What brings you to see the doctor today?” (Be prepared for the “My car” answer!)

The patient’s response should be recorded verbatim.

“I feel nauseous every time I eat.”

“I have had pain in my back for more than a week.”

The office visit or procedure may, in fact, be a routine one, such as an annual physical examination or a mammogram. If the patient is experiencing no symptoms and says I feel fine, the HCP should make note of this as well.

7 Perform a visual assessment of the patient. Make note of any observations, including:

■ Physical or 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 sit with their arms crossed tightly.

There may be times when the patient’s nonverbal communication conflicts with their verbal communication. In this instance, 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.

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 con-fusion on the part of the patient. A direct question is more likely to 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?”

10 Use simple questions and statements that the patient will under-stand. Healthcare professionals must communicate effectively and FIGURE 5-4. Visual Assessment. Visual assessment of the patient allows the HCP to make note of physical or psychological distress as well as any forms of nonverbal communication.

professionally with their colleagues as well as their patients. When communicating with colleagues, it is appropriate to use clinical terms as they are more accurate and informative. However, you should remember that most patients are unfamiliar with medical terminology and the language associated with a given medical spe-cialty. During the interview, 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?”

FIGURE 5-5. Simple Questions. The use of simple questions and statements, as well as common terms instead of medical terms, will facilitate the communication between the HCP and their patient.

PLAY

ROLE Using Simple Questions and Statements

With a partner, identify better ways of expressing the follow-ing messages to a patient:

a. The insulin will help you to avoid hyperglycemia.

b. Do you experience vertigo when you stand up too fast after lying down?

c. This diuretic is for your hypertension.

d. Osteoporosis is more prevalent in older women.

e. The cause of your dyspnea is the pulmonary embolism.

f. Your father has had a cerebrovascular accident.

g. Your baby has bilateral otitis again.

h. How long have you been experiencing this pharyngitis?

i. The burning you feel when you urinate may be due to nephritis.

j. This cancer treatment is likely to cause alopecia.

11 Give the patient time to answer fully before going on to the next question. Many individuals think out loud. The patient needs to fully process the question and then determine how they really want to answer it. As such, the true answer to the question may change over the course of the response. The practitioner should always be efficient; however, the patient should never feel rushed.

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.

Another important aspect of listening is being aware of what the patient has left out of their verbal response. This may also pro-vide important information regarding the patient’s feelings. The HCP should be entirely focused on the patient and listen closely to all responses. In this way, the interviewer will be able to record the most accurate facts and information. The occasional brief silence can slow the pace of the interview, allow you to make notations in the health record, and may also allow the patient to elaborate on their response.

FIGURE 5-6. Respond with Interest.Expressing interest in the patient’s message helps to maximize the patient’s verbal responses and to achieve a full understanding of the patient’s feelings.

Interest may be established by making encouraging or prompt-ing statements.

“That’s quite interesting.”

“Could you explain that more fully?”

“And then what happens?”

In this way, you will help to maximize the patient’s verbal responses.

13 Use continuers.The physical set-up of the interview area is often highly organized and efficient. In such an environment, patients may feel compelled to answer questions as briefly and concisely as possible. However, these responses may not provide all of the nec-essary information regarding their condition. As discussed previ-ously, the use of “continuers” may also help to draw out the patient and encourage them to elaborate. Examples of continuers include:

“What else?”

“Anything else?”

These expressions may allow the patient to reveal all of their thoughts and concerns. They may also allow the patient to verbalize their true chief complaint earlier in the interview.

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?”

Paraphrasing allows the HCP to immediately verify their understand-ing of the patient’s comments. It also allows the patient to hear what their words sound like. As a result, the patient may want to clarify what they said. Paraphrasing helps to build rapport between the inter-viewer and the interviewee. It confirms that the patient is actually being listened to. Paraphrasing maintains focus on the patient. Finally, it may keep the patient talking and encourage them to elaborate on their comments. However, you must be careful not to overuse this technique as it may become irritating to the patient.

15 Seek clarification. It is often helpful for the HCP to gently probe the patient and encourage them to offer further information.

“I’m 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.

“How often does that occur?”

“Could you describe that feeling more specifically?”

“Where is the pain?”

As with paraphrasing, this verbal feedback reassures the patient that you are listening closely.

PLAY

ROLE Paraphrasing and Seeking Clarification

With a partner—one of you as patient and one as HCP—act out each of the following scenarios in which the patient presents a complaint and the HCP paraphrases it back. If the patient is ambiguous, the HCP should seek clarification.

a. Henry is an 83-year-old man who complains to his wife Margaret about severe chest pain. Very concerned, his wife calls for an ambulance. Upon arrival at Henry’s home, the paramedic has a brief discussion with Henry about his symptoms.

b. Annie is a nutritionist at a nearby healthcare center. Her first patient of the day is an obese male high school sophomore. The goal of this visit is to assess his dietary patterns.

Discuss how these techniques enhanced the communication between the patient and the HCP. What clarification and further information was obtained as a result?

16 Verbalize the implied. Patients may not always express themselves directly. In this case, the HCP will have to infer, or derive 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 other topics is inappropriate, unprofessional, and wastes valuable time. However, there may be instances where patients need to vent and express their feelings.

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 (Figures 5-1 and 5-2). This space may be used by the HCP to document any other important information (e.g., race, age, loss of a loved one, or other stress-inducing life events). Certain races, ages, and genders have a higher disposition for certain diseases or disorders. For example, hypertension, or high blood pressure, is more prevalent in blacks than in whites. Ear infections 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.

FIGURE 5-7. Verbalize the Implied. The patient may not express himself directly. In this case, the HCP will have to infer, or derive a conclusion about, what the patient really means.

20 Immediately record the information.The HCP should immediately record 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 or procedure. Finally, thank the patient. (See “Sum-mary of Interviewing Guidelines” in Table 5-1)

Pinpointing the Chief Complaint or