THE CALGARY-CAMBRIDGE OBSERVATION GUIDE TO THE MEDICAL INTERVIEW

INITIATING THE SESSION

Establishing initial ra!rt
1. Gr""ts patient and obtains patients name
2. Intr!#$%"s self, role and nature of interview; obtains consent if necessary
3. D"&!nstrat"s r"s"%t and interest, attends to patients physical comfort
I#"nti'(ing th" r"as!n)s* '!r th" %!ns$ltati!n
4. I#"nti'i"s the patients problems or the issues that the patient wishes to address with appropriate !"ning +$"sti!n (e.g. !hat problems brought you to the hospital"# or !hat would you
li$e to discuss today"# or !hat %uestions did you hope to get answered today"#&
'. List"ns attentively to the patients opening statement, without interrupting ordirecting patients response
(. C!n'ir&s list an# s%r""ns for further problems (e.g. so thats headaches and tiredness; anything else))"#&
*. N"g!tiat"s ag"n#a ta$ing both patients and physicians needs into account
GATHERING IN,ORMATION
E-l!rati!n !' ati"nt.s r!bl"&s
+. En%!$rag"s ati"nt t! t"ll th" st!r( of the problem(s& from when first started to the present in own words (clarifying reason for presenting now&
,. Us"s !"n an# %l!s"# +$"sti!ning t"%hni+$", appropriately moving from open to closed
1-. List"ns attentively, allowing patient to complete statements without interruption and leaving space for patient to thin$ before answering or go on after pausing
11. ,a%ilitat"s patient.s responses verbally and non/verbally e.g. use ofencouragement, silence, repetition, paraphrasing, interpretation
12. /i%0s $ verbal and non/verbal %$"s (body language, speech, facial e0pression, affect&; %h"%0s !$t an# a%0n!1l"#g"s as appropriate
13.Clari'i"s patients statements that are unclear or need amplification (e.g. 1ould you e0plain what you mean by light headed2&
14. /"ri!#i%all( s$&&aris"s to verify own understanding of what the patient has said; invites patient to correct interpretation or provide further information.
1'. Us"s concise, "asil( $n#"rst!!# +$"sti!ns an# %!&&"nts, avoids or ade%uately e0plains 3argon
1(. Establish"s #at"s an# s"+$"n%" of events
A##iti!nal s0ills '!r $n#"rstan#ing th" ati"nt.s "rs"%ti2"
1*. 4ctively #"t"r&in"s an# ar!riat"l( "-l!r"s5
patients i#"as (i.e. beliefs re cause&
patients %!n%"rns (i.e. worries& regarding each problem
patients "-"%tati!ns (i.e., goals, what help the patient had e0pected for each problem&
effects5 how each problem a''"%ts the patients life
1+. En%!$rag"s ati"nt t! "-r"ss '""lings
/ROVIDING STRUCTURE
Ma0ing !rganisati!n !2"rt
1,. S$&&aris"s at the end of a specific line of in%uiry to confirm understanding before moving on to the ne0t section
2-. 6rogresses from one section to another using sign!sting3 transiti!nal stat"&"nts; includes rationale for ne0t section
Att"n#ing t! 'l!1
21. 7tructures interview in l!gi%al s"+$"n%"
22. 4ttends to ti&ing and $eeping interview on tas$
BUILDING RELATIONSHI/
Using ar!riat" n!n-2"rbal b"ha2i!$r
23. D"&!nstrat"s ar!riat" n!n42"rbal b"ha2i!$r
eye contact, facial e0pression
posture, position 8 movement
vocal cues e.g. rate, volume, tone
24. 9f reads, writes n!t"s or uses computer, does in a &ann"r that #!"s n!t int"r'"r" 1ith #ial!g$" !r ra!rt
2'. D"&!nstrat"s appropriate %!n'i#"n%"
D"2"l!ing ra!rt
2(. A%%"ts legitimacy of patients views and feelings; is not 3udgmental
2*. Us"s "&ath( to communicate understanding and appreciation of the patients feelings or predicament; overtly a%0n!1l"#g"s ati"nt5s 2i"1s and feelings
2+. /r!2i#"s s$!rt5 e0presses concern, understanding, willingness to help; ac$nowledges coping efforts and appropriate self care; offers partnership
2,. D"als s"nsiti2"l( with embarrassing and disturbing topics and physical pain, including when associated with physical e0amination
In2!l2ing th" ati"nt
3-. Shar"s thin0ing with patient to encourage patients involvement (e.g. !hat 9m thin$ing now is....#&
31. E-lains rati!nal" for %uestions or parts of physical e0amination that could appear to be non:se%uiturs
32. ;uring h(si%al "-a&inati!n, e0plains process, as$s permission
E6/LANATION AND /LANNING
/r!2i#ing th" %!rr"%t a&!$nt an# t(" !' in'!r&ati!n
33. Ch$n0s an# %h"%0s7 gives information in manageable chun$s, chec$s for understanding, uses patients response as a guide to how to proceed
34. Ass"ss"s ati"nt.s starting !int7 as$s for patients prior $nowledge early on when giving information, discovers e0tent of patients wish for information
3'. As0s ati"nts 1hat !th"r in'!r&ati!n 1!$l# b" h"l'$l e.g. aetiology, prognosis
3(. Gi2"s "-lanati!n at ar!riat" ti&"s7 avoids giving advice, information or reassurance prematurely
Ai#ing a%%$rat" r"%all an# $n#"rstan#ing
3*. Organis"s "-lanati!n7 divides into discrete sections, develops a logical se%uence
3+. Us"s "-li%it %at"g!risati!n !r sign!sting (e.g. <here are three important things that 9 would li$e to discuss. 1st...# =ow, shall we move on to.#&
3,8 Us"s r""titi!n an# s$&&arising to reinforce information
4-. Us"s concise, "asil( $n#"rst!!# lang$ag", avoids or e0plains 3argon
41. Us"s 2is$al &"th!#s !' %!n2"(ing in'!r&ati!n7 diagrams, models, written information and instructions
42. Ch"%0s ati"nt.s $n#"rstan#ing of information given (or plans made&5 e.g. by as$ing patient to restate in own words; clarifies as necessary
A%hi"2ing a shar"# $n#"rstan#ing7 in%!r!rating th" ati"nt.s "rs"%ti2"
43. R"lat"s "-lanati!ns t! ati"nt.s illn"ss 'ra&"1!r07 to previously elicited ideas, concerns and e0pectations
44. /r!2i#"s !!rt$niti"s an# "n%!$rag"s ati"nt t! %!ntrib$t"7 to as$ %uestions, see$ clarification or e0press doubts; responds appropriately
4'. /i%0s $ 2"rbal an# n!n-2"rbal %$"s e.g. patients need to contribute information or as$ %uestions, information overload, distress
4(. Eli%its ati"nt5s b"li"'s3 r"a%ti!ns an# '""lings re information given, terms used; ac$nowledges and addresses where necessary
/lanning7 shar"# #"%isi!n &a0ing
4*. Shar"s !1n thin0ing as ar!riat"7 ideas, thought processes, dilemmas
4+. In2!l2"s ati"nt by ma$ing suggestions rather than directives
4,. En%!$rag"s ati"nt t! %!ntrib$t" th"ir th!$ghts7 ideas, suggestions and preferences
'-. N"g!tiat"s a mutually a%%"tabl" lan
'18 O''"rs %h!i%"s7 encourages patient to ma$e choices and decisions to the level that they wish
'2. Ch"%0s 1ith ati"nt if accepts plans, if concerns have been addressed
CLOSING THE SESSION
,!r1ar# lanning
'3. C!ntra%ts with patient regarding the ne0t steps for patient and physician
'4. Sa'"t( n"ts, e0plaining possible une0pected outcomes, what to do if plan is not wor$ing, when and how to see$ help
Ens$ring ar!riat" !int !' %l!s$r"
''. S$&&aris"s s"ssi!n briefly and clarifies plan of care
'(. ,inal %h"%0 that patient agrees and is comfortable with plan and as$s if any corrections, %uestions or other items to discuss
,URTHER O/TIONS IN E6/LANATION AND /LANNING
I, #is%$ssing in2"stigati!ns an# r!%"#$r"s
'*. 6rovides clear information on procedures, eg, what patient might e0perience, how patient will be informed of results
'+. >elates procedures to treatment plan5 value, purpose
',. ?ncourages %uestions about and discussion of potential an0ieties or negative outcomes
I, #is%$ssing !ini!n an# signi'i%an%" !' r!bl"&
(-. @ffers opinion of what is going on and names if possible
(1. >eveals rationale for opinion
(2. ?0plains causation, seriousness, e0pected outcome, short and long term conse%uences
(3. ?licits patients beliefs, reactions, concerns re opinion
I, n"g!tiating &$t$al lan !' a%ti!n
(4. ;iscusses options eg, no action, investigation, medication or surgery, non:drug treatments (physiotherapy, wal$ing aides, fluids, counselling, preventive measures&
('. 6rovides information on action or treatment offered name steps involved, how it wor$s benefits and advantages possible side effects
((. @btains patients view of need for action, perceived benefits, barriers, motivation
(*. 4ccepts patients views, advocates alternative viewpoint as necessary
(+. ?licits patients reactions and concerns about plans and treatments including acceptability
(,. <a$es patients lifestyle, beliefs, cultural bac$ground and abilities into consideration
*-. ?ncourages patient to be involved in implementing plans, to ta$e responsibility and be self:reliant
*1. 4s$s about patient support systems, discusses other support available
(Source: Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Cmmunicatinn S!ill" in Medicine# $adcli%%e Medical &re"", '(%rd#)