3 Communication and Patient Centred Interviewing

Question 1

Q: What does PC stand for?

Answer 1

A: Presenting complaint

Question 2

Q: What does HPC stand for?

Answer 2

A: History of the Presenting Complaint

Question 3

Q: What does PMH stand for?

Answer 3

A: Past Medical History

Question 4

Q: What does SH stand for?

Answer 4

A: Social History

Question 5

Q: What does FH stand for?

Answer 5

A: Family History

Question 6

Q: What does LS stand for?

Answer 6

A: Lifestyle

Question 7

Q: What does FE/SR stand for?

Answer 7

A: Functional enquiry/systems review

Question 8

Q: How do you commence the interaction? (7)

Answer 8

A: Greet the patient

State your full name and clarify your role

Obtain patient’s name

Obtain the patient’s consent

Clarify confidentiality

State purpose of the interaction

Clarify time available

Question 9

Q: What should you do throughout the interaction? (2)

Answer 9

A: Attend to patient’s comfort

Empower the patient to ask questions or seek clarification of anything that is unclear

Question 10

Q: How should you greet the patient? Hands?

Answer 10

A: A formal greeting should be used (e.g. “Hello” “Good morning” etc).

Shaking hands with patients during your greeting is not essential but is often welcomed by patients.

Question 11

Q: What can happen if a patient feels uncomfortable?

How can you attend to the patient’s comfort? (3)

Answer 11

A: less likely to be able to spend time with you and unable to concentrate

Look at your patient to see if they are in pain and respond to what you see. It is helpful to share our observation with your patient. (e.g. “You don’t seem very comfortable on that chair…?”)

Note physical aspects of the environment that contribute to comfort - the temperature of the room, draughts, noise, furniture, bedding etc.

Facial expressions are also often indicative of a patient’s level of comfort.

Question 12

Q: How can you empower the patient to ask questions or seek clarification of anything that is unclear?

Answer 12

A: Patients can be invited to ask questions (even though you may not have the answers) as well as to check with you if there is anything you have said that is unclear. (e.g. “If anything I say is unclear, please let me know and I will explain.” “Please feel free to ask me questions at anytime during the interview,” “If you have any questions about what I am doing, please just ask”).

Question 13

Q: How should information be gathered? (6)

Answer 13

A: Use open-ended questions initially (closed later)

Identify the patient’s ideas, concerns and expectations (ICE)

Don’t interrupt

Use non-verbal behaviours

Pick up non/verbal cues

Make interim summaries // signpost or make transition statements

Question 14

Q: What should be avoided during an interaction? (4)

Answer 14

A: multiple questions

leading questions

unexplained jargon

being judgemental

Question 15

Q: What are open-ended questions designed to enable? eg? (2)

Answer 15

A: patient to provide a more open, elaborate response, other than yes or no

“Can you tell me what brings you here to the clinic today?”

“Can you describe the symptoms for me? ”

Question 16

Q: What are closed-ended questions designed to

produce? When are they useful? (2)

Answer 16

A: more restricted response from the patient (e.g. yes or no).

when you need to narrow the focus of the discussion to more specific topics, or in circumstances where the patient may not be in a fully conscious state

Question 17

Q: Examples of non verbal behaviour? (5)

Answer 17

A: eye contact, body posture, gestures, facial expressions, touch

Question 18

Q: What does a doctor’s nonverbal behaviour need to convey to the patient?

Answer 18

A: that he or she is the focus of your attention

Question 19

Q: Non-verbal behaviours include? (4)

Answer 19

A: facial expressions, eye contact and body positioning and attention

Question 20

Q: What should you not assume about the patient? Should? However, it is important to remember that?

Answer 20

A: they have just one or two presenting
complaints or symptoms

Always explore for more

patients do not always feel comfortable telling everything at once, especially if they do not know you.

Question 21

Q: What is the use of interim summaries? Conveys to the patient that? Another use?

Answer 21

A: check and clarify what you have understood

you have been listening.

give yourself some time to reflect on which direction to move into next particularly if you lose your train of thought.

Question 22

Q: Why is the use of signposting or transition statements critical?

Answer 22

A: they link the interview together. They provide direction so you and the patient know where you’ve been and what’s coming next.

Question 23

Q: Why are silences useful for patients? How can they be used to get a patient to share more?

Answer 23

A: often need more time than others to respond to questions

remaining silent, nodding and maintaining eye contact, after the patient has spoken can sometimes be interpreted by the patient as a ‘go-ahead’ signal resulting in them telling you more.

Question 24

Q: Why should a multiple question be avoided?

Answer 24

A: Asking a multiple question increases the possibility of the patient answering only one part of the question which can have a negative impact on your information gathering

Question 25

Q: Why should leading questions be avoided?

Answer 25

A: These are biased and sometimes judgemental questions that may lead the patient to agree with you rather than eliciting accurate information.

Question 26

Q: How should an interaction be closed?

Answer 26

A: Provide an end summary

Discuss an action plan

Check for further information/ ask for questions

Check if the patient has any worries or concerns

Display Empathy

Question 27

Q: What’s the use in providing an end summary? (4)

Answer 27

A: It means that you can check with the patient the accuracy of your information

leave the patient with a sense of what they and you thought important.

Lasting impressions can be important in the same way
that positive first ones are important to make

It also signals to the patient that you are about to finish.