Jarvis: Physical Examination & Health Assessment, 6th Edition

Chapter 3: The Interview

Key Points Print

This section discusses key points about the communication process and techniques.
A health interview is a structured interaction between you and the patient. The rules
governing this interaction should be clearly outlined and agreed on by you and the patient
at the start of the interview. Your mutual goal is the patients optimal health.
Communication carries you and the patient through the interview. Communication is the
exchange of information so that each person clearly understands the other.
A two-person interaction usually has two roles: sender and receiver. When exchanging
information, both individuals engage in verbal and nonverbal communication. Internal and
external factors can affect communication.
o Internal factors are what you bring to the interview. Three internal factors promote
good communication: liking others, expressing empathy, and having the ability to
listen.
o External factors relate mainly to the physical setting. You can foster good
communication with certain external factors, such as by ensuring privacy,
preventing interruptions, creating a conducive environment, and documenting
responses without interfering with the conversation.
The interview has three phases: an introduction, a working phase, and a closing.
o During the first phase, introduce the interview.
o During the working phase, gather data. Start with open-ended questions, which ask
for narrative information. Then use closed questions, which ask for specific
information in short, one- or two-word answers.
o During the closing, signal that the interview is ending, which gives the patient one
last chance to share concerns or express himself or herself. Also briefly summarize
what you learned during the interview.
You can use different types of verbal responses to assist the narrative and help gather data.
Each response plays a role in the interview process, but practice is needed to use them
effectively and move among them smoothly.

Elsevier items and derived items 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Key Points Print 3-2

o Through facilitation, silence, reflection, empathy, and clarification, you react to the
facts or feelings the patient has communicated. Your response focuses on the
patients frame of reference.
o Through confrontation, interpretation, explanation, and summary, your response
focuses on your own frame of reference, thoughts, and feelings.

To further enhance communication, avoid the ten traps of interviewing. These

nonproductive verbal messages include:
o Providing false assurance or reassurance,
o Giving unwanted advice,
o Using authority,
o Using avoidance language,
o Engaging in distancing,
o Using professional jargon,
o Using leading or biased questions,
o Talking too much,
o Interrupting,
o And using why questions.

Pay attention to nonverbal modes of communication, which include:

o Physical appearance,
o Posture,
o Gestures,
o Facial expression,
o Eye contact,
o Voice,
o And touch.

Nonverbal communications convey messages from the sender to the receiver. Work to
develop the ability to read patients nonverbal behaviors and to monitor your own nonverbal
communication.

Elsevier items and derived items 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Key Points Print 3-3

This section presents critical points about communication in special situations.

Modify communication techniques based on each patients developmental stage, including
parents, infants, young children, adolescents, and older adults.
Learn to communicate effectively with patients who have special needs, such as those with
a hearing impairment, acute illness, or intoxication and those who are sexually aggressive,
angry, anxious, violent, or in tears.
When a patient comes from a different culture, modify your approach as needed.
Behaviors that one culture views positively may have different, possibly negative,
connotations in another culture.
For a patient with limited English proficiency, use a bilingual team member or a trained
medical interpreter whenever possible. Avoid using a family member or close friend as an
interpreter because this violates the patients confidentiality.

Elsevier items and derived items 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.