Interviewing Techniques as Tools for Diagnosis and Treatment,

part 1:The Basics

Interviewing Techniques as Tools for Diagnosis and Treatment,

part 1:The Basics

The Practice of Medicine - 1Christine M. Peterson, M.D.

50-minute

lectures

Small groups this week: Session 2Small groups this week: Session 2Small groups this week: Session 2Small groups this week: Session 2

Mentor interview 1) Recognize the purposes and functions

(process and content) of the medical interview.

2) Observe and participate in the feedback process

Small groups next two weeksSmall groups next two weeksSmall groups next two weeksSmall groups next two weeks Sessions 3A and 4B: Standardized Patient Interview

Students will: Practice eliciting a Chief Concern and taking a History of the Present Illness Practice:

opening physical environment active listening body language and non-verbal communication dealing with feelings closing

Elicit the patients’ story Give and receive feedback

Small groups next two weeksSmall groups next two weeksSmall groups next two weeksSmall groups next two weeks Sessions 3B and 4A: Hospital Patient Interview

Students will: Practice eliciting a Chief Concern and taking a History of

the Present Illness Practice specific interviewing skills and observe how a

patient responds to them Elicit how the patient is coping with illness and how illness

is affecting the patient and family Evaluate an interview done by a fellow student and give

feedback

What would you like to learn today?What would you like to learn today?What would you like to learn today?What would you like to learn today?

Write down up to three skills that you would like to learn today on a card.

Give the card to someone else.

Techniques as Tools 1 & 2Techniques as Tools 1 & 2 Learning Objectives:

Name purposes and functions of the medical interview

Learn non-verbal behaviors &verbal techniques and responses

Practice using and observing skills

Have you had any formal Have you had any formal training in interviewing?training in interviewing?Have you had any formal Have you had any formal training in interviewing?training in interviewing?

1. Yes

2. No

Time Spent Relating to Patients in Med School – and Afterwards

Time Spent Relating to Patients in Med School – and Afterwards

0%

100%

1st Year 2ndYear

3rd &4th Year

Int/Res Practice

OtherSciencePatients

What is the purpose of the doctor-patient encounter?

“Dr. Google”: In the age of the internet, why would anyone want to see a physician?

Physicians can provide:Physicians can provide: Special expertise and judgment Special skills

Unique socially sanctioned “powers”

Shared vulnerability = empathy

Purposes of the medical encounterPurposes of the medical encounter

Evaluate

Treat

Relieve suffering andmaximize functioning

Purposes of the Medical EncounterPurposes of the Medical Encounter

Help the patient by Relieving suffering Maximizing functioning

Special expertise and judgment

Special skills

Sharing vulnerability

Basic Unit of Clinical WorkBasic Unit of Clinical Work

History Chief Complaint/Concern History of Present Illness Past Medical History Family History Social History (incl. Health Habits, Lifestyle) Review of Systems

Physical Exam

[Other Clinical Work[Other Clinical Work Selection and interpretation of

lab tests, imaging studies, etc. Diagnostic procedures Therapeutic procedures]

Communication of Clinical WorkCommunication of Clinical Work “Write-up” (medical record, chart)

and oral presentation (“rounds” and consultation) History Physical Exam Laboratory Tests Differential Diagnosis

Impression / Assessment Plan

What are the functions of the medical interview?

Functions of the Medical InterviewFunctions of the Medical Interview Gather data and understand it Develop rapport and respond to emotions Educate and motivate

Begin both diagnostic and healing processes

An AnalogyAn Analogy

A social conversation is to a medical interview as...

tying your shoes is toperforming brain surgery.

A good physician can talk

to anyone…

But a great physician can listen to anyone.

Non-Verbal Behavior in Active ListeningNon-Verbal Behavior in Active Listening

Non-Verbal Behavior(Behavior that BEFITS a physician)

Non-Verbal Behavior(Behavior that BEFITS a physician)

Body posture and movements Eye contact Facial expression Inflection, tone of voice and rate of

speech Touch Space between doctor and patient

Non-verbal BehaviorNon-verbal BehaviorNon-verbal BehaviorNon-verbal Behavior

B E F I T S

Verbal Techniques Used in Active Listening

Verbal Techniques Used in Active Listening

Verbal Techniques Used in Active Listening

Verbal Techniques Used in Active Listening

((FOCUS FOCUS on active listening)on active listening) Facilitations Open-ended questions Clarification and direction Understanding by checking Surveying problems

Verbal Techniques Used in Active Listening

Verbal Techniques Used in Active Listening

F O C U S

American Academy on Communication in Healthcare

American Academy on Communication in Healthcare

AACHonline.org Doc.com

15 day free trial membership 1 year membership for $95 each 10 or more users for $45 each

What about the patient as a person?What about the patient as a person?

Information about the Patient as a PersonInformation about the Patient as a Person

(PREP for more information) Priorities for the patient Expectations that the patient

has Patient’s ideas about the

meaning of the illness

What about the patient as a person?What about the patient as a person?

(PREP for more information) Pr E P