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Use of the interv iewing techniques such as reflection,
legitimation, support,
partnership, respect, empathy, unconditional positive regard,
avoidance of sham,eand
huMiliation and nonverbal skills contribute to interview
efficiency and to rapport,
ExamplesReflection: "You seem to be very upset about this
issue."
Legitimation: "1 can certainly understand why taing medications
is so difficult
for you."Support: "! want you to now that ! am here to help you
through this difficultdecision."
Partnership: "hen how would you lie to be helped now #"
Respect: "it is really nice to sec you coming to the clinic on
your own, despite how
difficult it is for you."mpathy: "1 understand your
suffering."!nconditional positive regard: " admire how you eep
trying."
#voidance of shame and humiliation: "$ow could you forget that
#"
$onverbal skills: touch, positive eye contact.o maintain
rapport, the physician needs to handle the patient%s emotions
appropriately.
hroughout the interview, the physician should remain aware of
and responsive to
emotions when they become apiltent and when they ought to be
present but are not.
&art of history taing involves sharing control and decision
maing. his "activates" the
patient as an agent of his or her own care and has been shown to
improve biologic outcome.
&atients who feel understood by their physicians are
generally more satisfied and feelbetter, which in turn brings more
satisfaction to the physician.
Use of the simple sills 'examples listed below( influences
adierence to treatmentrecommendations )
1("*ould you tell me your understanding of diabetes and its
causes # " 'this meansestablishing baseline knowledge and
attributions);
+("You have a positive && 'purified protein defivative()
this means that the "germs" -
of tuberculosis entered your body, went to your lungs and feel
asleep. You do not have
tuberculosis." (avoidance of the complex medical
terminology);
("/ust to mae sure that ! have made myself clear, can you tell
me how you will betaing the medications at home#" (checking).
&atierts will better understand the nature of their illness,
the suggested diagnostic
pr0e2res, and the treatment possibilities.
Unless physician andpatient negotiate agreement regarding the
nature of the problem,
the patient will not comply.
3fter the patient fully understands the disease process, the
physician and patient can
achieve an alliance for the patient%s care ,T.))information
provided to the patient should bebrief. !t is important to remember
thaty4ixiety interferes with the ability to understand the
are first told about an illness.illness and most patients are
quite anxibu,s when they1 -, 5>'.7!rutiaily, the physician
should stic to a few ey points.
The Structural Elements of the Interview
areful structuring of the interview is central to *fgetivieness.
Each of the 16 structuralelements must be used. hey are
(%&optimi'ing the environment , &
