Behavioral Medicine: A Guide for Clinical Practice, 5e >The Medical Interview

Mitchell D. Feldman, John F. Christensen, Jason M. Satterfield, Ryan Laponis+

Table 1-3.Structural elements of the medical interview.

Element Technique or Behavior

Create a private area.

Eliminate noise and distractions.

Prepare the environment

Provide comfortable seating at equal eye level.

Provide easy physical access.

Eliminate distractions and interruptions.

Focus through:

Self-hypnosis
Prepare oneself

Meditation

Constructive imaging

Let intrusive thoughts pass.

Create a personal list of categories of observation.

Practice in a variety of settings.

Observe the patient

Notice physical signs.

Notice patient’s presentation and affect.

Notice what is said and not said.

Create a flexible personal opening.

Introduce oneself.
Greet the patient

Check the patient’s name and how it is pronounced.

Create a positive social setting.

Explain one’s role and purpose.

Check patient’s expectations.

Begin the interview

Negotiate about differences in perspective.

Be sure your expectations are congruent with patient’s expectations.

 Be aware of and look for potential barriers:

Language

Detect and overcome barriers to communication

Physical impediments such as deafness, delirium

Cultural differences

Psychological obstacles such as shame, fear, and paranoia

Develop personal methods to elicit problems.

Survey problems

Ask “what else” until problems are described.

Ask patient for his or her priorities.

State your own priorities.

Negotiate priorities

Establish mutual interests.

Reach agreement on the order of addressing issues.

Develop personal ways of asking patients to tell their story:

When did patient last feel healthy?

Develop a narrative thread

Describe entire course of illness.

Describe recent episode or typical episode.

Use first opportunity to inquire about personal and social details.

Flesh out developmental history.

Establish the life context of the patient

Learn about patient’s support system.

Learn about home, work, neighborhood, and safety issues.

Memorize complete review of systems.

Establish a safety net

Review issues as appropriate to specific problems.

 Be succinct.

Ascertain patient’s level of understanding and cognitive style.

Ask patient to review and state understanding.

Present findings and options

Summarize and check.

Record interview and give copy of recording to patient.

Ask patient’s perspectives.

Involve patient actively.

Negotiate plans
Agree on what is feasible.

Respect patient’s choices whenever possible.

Ask patient to review plans and arrangements.

Schedule next encounter.

Close the interview

Clarify what patient should do in the interim.

Say good-bye.

Date of download: 12/26/22 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.