Modalidad Educativa

There are two types of questions that the HCP will ask the patient dur-ing 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 in Figure 5-1 consists predominantly of this type of question.

FIGURE 5-1. Detailed Report of Medical History Form. (continued)

“Have you ever had rheumatic fever?”

“Have you ever had jaundice or hepatitis?”

“Do you use tobacco?”

Other examples of closed questions that the HCP may ask the patient during an interview include the following:

“Are you taking your medication as directed?”

“Do you feel nauseous now?”

FIGURE 5-1. (Continued)

“Where does it hurt?”

“Did you have a fever this morning?”

“You said that you have had high blood pressure for the past 3 years, correct?”

“Are you available for an ultrasound on Thursday?”

Closed questions quickly provide a great deal of objective infor-mation about the patient. The HCP will often have only 15 minutes with the patient, and these questions will allow for the most efficient communication.

Conversely, much important information, both objective and sub-jective, 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 help to establish therapeutic communication and a relationship between the patient and the HCP. The patient is required to provide more explanation when responding to these questions. Furthermore, the HCP has the opportunity to paraphrase the patient’s response and empathize with the patient.

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 does 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.”

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 motiva-tion is often complex. In addimotiva-tion, these quesmotiva-tions may be perceived as confrontational. The patient may feel as though they have to defend them-selves, and this is likely to inhibit further communication and damage the therapeutic relationship between the practitioner and the patient.

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. Consider the following questions:

“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 standing of how the patient feels about the given issue. Better under-standing between the HCP and the patient often leads to enhanced patient compliance and improved health outcomes.

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 encour-age 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.

Another technique that may be employed during the patient interview involves the use of indirect statements. As with 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 state-ments 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.”

“I would like to know more about these headaches you have been getting.”

In addition to the section including “yes or no” questions, the Detailed Report of Medical History also has a section where explana-tions to various quesexplana-tions may be noted. Examples of these quesexplana-tions 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. As indicated in section

#25 of Figure 5-1, the HCP “may develop by interview any additional med-ical history deemed important, and record any significant findings here.”

The HCP-centered Interview versus the