1/2/07

The Medical Interview

The "medical interview" is the interaction a medical student or a doctor has with a patient. According to Skills for communicating with patients (1998) by Silverman, Kurtz and Draper, the medical interview can be separated into various phases:

1). Preparation
Prepare for the medical interview by cultivating full concentration. This can be done by putting aside the last task, attending to your personal needs and comfort (hunger, sleep, heat), reading any notes already available, and meet your patient with only him/her in your mind.

2). Introduction
Surprisingly, introductions are often skipped by doctors as they tend to attack the presenting complaint on its arrival. An introduction should include: name, position (if a medical student, then in what year? if a doctor, then what role in the treatment?), obtaining the patient's name, and then asking permission to conduct the medical interview (getting the patient's consent to be interviewed). "[smile, eye contact, and a friendly-ish greeting] Hello, I'm Doctor ______. Please come in and take a seat."

3). Consent
The medical interview can become a lot of just talking, but it's still important, especially when it comes to taking consent (asking the patient if he/she agrees to have hte interview). There is a misconception that a patient gives his/her consent to treatment as soon as he enters through the hospital doors, but that is not necessarily the case. "Hi, my name is ______ and I'm a second year medical student working with Doctor ______ who told me to take ten, fifteen, minutes talking to you before he joins us. Is that alright with you?"

4). Make Patient Comfortable
a). Privacy: draw curtains (around a ward) or go to a private consulting room
b). Verbal communication: don't talk loudly, angrily, hurriedly,
c). Non-verbal communication: easy eye contact (but not so much that the patient can't escape), sitting at equal footing with patient, not hiding behind a large desk or computer.
d). Patient's comfort: is the patient comfortable? fully dressed? in an appropriate environment? on a busy schedule?

5). Opening Question
The first question of the medical interview should be an open question, such as "How are you feeling today? What would you like to talk about today?"

6). Medical Interview
A helpful mnemonic to remember when conducting the medical interview is WWQQAAB:
W - What/Where
W - When
Q - Quality
Q - Quantity
A - Aggrevating/Alleviating factors
A - Associated symptoms
B - Beleifs
(More on this later)

7). Make No Assumptions
It is important not to make any assumptions. A high percentage of people that take alternative medicine (~75%) do not inform their doctors, often have more than one presenting complaint, the series in which patients present their problems is in no order (of importance), often the patient will talk more about the presenting complaint if allowed a moment of silence, do not interrupt the patient (this happens surprisingly frequently - doctors can usually only keep quite for an average of 18 seconds in the patient's opening complaint), encourage patients to elaborate or continue ("Yes, go on."), and double-check on all material before assuming ("Is there any other symptom you've been having?").

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