Catherine Goodman

Teresa Snyder

Chapter
Introduction to the Interviewing
2 Process

DR FATIMA AMJAD PT
Intro to Interviewing Process
The patient/client interview, including the personal and family history, is the single most
important tool in screening for medical disease.
It is first step in the screening process.
Interviewing is an important skill for the clinician to learn.
Medical practitioners (including nurses, physicians, and therapists) begin the interview by
determining the client's chief complaint.
◦ The chief complaint is usually a symptomatic description by the client (i.e., symptoms reported for
which the person is seeking care or advice).
◦ The present illness, including the chief complaint and other current symptoms, gives a broad, clear
account of the symptoms—how they developed and events related to them.
Concepts In Communication
Interviewing is a skill that requires careful nurturing and refinement over time.
Taking an accurate medical history can be a challenge.
Clients' recollections of their past symptoms, illnesses, and episodes of care are often inconsistent
from one inquiry to the next.
Clients may forget, underreport, or combine separate health events into a single memory, a process
called telescoping.
They may even (intentionally or unintentionally) fabricate or falsely recall medical events and
symptoms that never occurred. The individual's personality and mental state at the time of the
illness or injury may influence their recall abilities.
Adopting a compassionate and caring attitude, monitoring your communication style, and being
aware of cultural differences will help ensure a successful interview.
Compassion and Caring
Compassion is the desire to identify with or sense something of another's experience and is a
precursor of caring.
Caring is the concern, empathy, and consideration for the needs and values of others.
Interviewing clients and communicating effectively, both verbally and nonverbally, with
compassionate caring takes into consideration individual differences and the client's emotional
and psychological needs.
Establishing a trusting relationship with the client is essential when conducting a screening
interview and examination.
A client who is comfortable physically and emotionally is more likely to offer complete
information regarding personal and family history.
Communication Styles
Everyone has a different interviewing and communication style. The interviewer may need to
adjust his or her personal interviewing style to communicate effectively.
Relying on one interviewing style may not be adequate for all situations.
1. gender-based styles
2. temperament/personality-based styles
There are cultural differences based on family of origin or country of origin, again for both the
therapist and the client.
In addition to spoken communication, different cultural groups may have nonverbal, observable
differences in communication style.
Body language, tone of voice, eye contact, personal space, sense of time, and facial expression are
only a few key components of differences in interactive style.
Interviewing Do’s and Don’t
DO’s:
Do use a sequence of questions that begins open—ended questions.
Do leave closed—ended questions for the end.
Do select a private location where confidentiality can be maintained
Do listen attentively
Do ask one question at a time
Do encourage the client to ask questions
Do listen with the intention of assessing the client level of understanding of his/her medical issue.
Do correlates signs and symptoms with medical history and objective findings to rule out
systemic disease
DON’Ts:
Don’t jump to premature conclusion
Don't interrupt or take over the conversation when the client is speaking.
Don't destroy helpful open-ended questions
Don't use professional or medical terms
Don't overreact to information presented
Don't use leading questions
Cultural competence in screening process
Cultural competence can be defined as the ability to understand, honor, and respect the beliefs,
lifestyles, attitudes, and behaviors of patient/client.
As health care professionals, we must develop a deeper sense of understanding of how ethnicity,
language, cultural beliefs, and lifestyles affect the interviewing, screening, and healing process.
THE SCREENING INTERVIEW
Interviewing Techniques
Interviewing Tools
Interviewing Techniques
An organized interview format assists the therapist in obtaining a complete and accurate
database. The most basic skills required for a physical therapy interview include:
• Open-ended questions
• Closed-ended questions
• Funnel sequence or technique
• Paraphrasing technique
Open ended and Close ended question
Start the interview with open ended question (i.e., questions that elicit more than a one word
response) is advised, even though this gives the client the opportunity to control and direct the
Interview then begin a steady stream of close ended questions (Yes and No).
Use of the funnel sequence to obtain as much information as possible through the open-ended
format first (before moving on to the more restrictive but clarifying "yes" or "no" type of
questions at the end) can establish an effective forum for trust between the client and the
therapist.
F O L L O W - U P Q U E S T I O N S (FUPs)
The funnel sequence is aided by the use of follow up questions.
Beginning with one or two open-ended questions in each section, the interviewer may follow up
with a series of closed-ended questions
Paraphrasing Technique
A useful interviewing skill that can assist in synthesizing and integrating the information obtained
during questioning is the paraphrasing technique.
When using this technique, the interviewer repeats information presented by the client. This
technique can assist in fostering effective, accurate communication between the health care
recipient and the health care provider.
Interviewing Tools
Documenting the effectiveness of intervention is called outcomes management.
Using standardized tests, functional tools, or questionnaires to relate pain, strength, or range of
motion to a quantifiable scale is defined as outcome measures.
The information obtained from such measures is then compared with the functional outcomes
of treatment to assess the effectiveness of those interventions.
Pain assessment is often a central focus of the therapist's interview, in quantifying pain, some
way to quantify and describe pain is necessary. There are numerous pain assessment scales
designed to determine the quality and location of pain or the percentage of impairment or
functional level associated with pain.
• Visual Analogue Scale (VAS)
• Verbal Descriptor Scale
SUBJECTIVE EXAMINATION
The subjective examination is usually thought of as the "client interview." It is intended to provide a
database of information that is important in determining the need for medical referral or the direction
for physical therapy intervention. Key Components of the Subjective Examination
The subjective examination must be conducted in a complete and organized manner. It includes several
components, all gathered through the interview process.
Personal/Family History
Patient and patient’s family
Age, previous illness, surgical history, allergies, medications history, and family
medical history.
After this the clinician can then follow up with appropriate questions based on any "yes“ and “no”.
CORE INTERVIEW
After taking the personal/family history form the therapist starts the core interview.
It consists of:
History of Present Illness
 Chief Complaint
 Pain and Symptom Assessment
Medical Treatment and Medications
Current Level of Fitness
Sleep-related History
Stress (Emotional/Psychologic screen)
Final Questions
Associated Signs and Symptoms
HISTORY OF PRESENT ILLNESS
Chief Complaint (Onset)
• Tell me why you are here today.
• Tell me about your injury.
Alternate question: What do you think is causing your problem/pain?
FUPs: How did this injury or illness begin?
° Was your injury or illness associated with a fall, trauma, assault, or repetitive activity (e.g., painting,
cleaning, gardening, filing papers, driving)?
° Have you been hit, kicked, or pushed?
° When did the present problem arise and did it occur gradually or suddenly?
Systemic disease: Gradual onset without known cause, progressive, cyclical onset: worse, better worse.
Pain and Symptom Assessment
Do you have any pain associated with your injury or illness?
If yes, tell me about it.
Location
• Show me exactly where your pain is located.
FUPs: Do you have this same pain anywhere else?
° Do you have any other pain or symptoms anywhere else?
° If yes, what causes the pain or symptoms to occur in this other area?
Description And Pattern
• What does it feel like?
Has the pain changed in quality, intensity, frequency, or duration (how long it lasts] since it first
began?
Pattern
• Tell me about the pattern of your pain or symptoms,
Alternate question: When does your back/shoulder [name the body part] hurt?
° How does your pain/symptom’s change with time?
° Are your symptoms worse in the morning or in the evening?
FREQUENCY
How often does the pain/symptom’s occur?
FUPs: Is your pain constant, or does it come and go intermittent?
Are you having this pain now?
° Did you notice these symptoms this morning?
DURATION
• How long does the pain/symptom’s last?
Systemic disease: Constant.
INTENSITY
On a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you have experienced
with this condition, what level of pain do you have right now?
Alternate question: How strong is your pain?
1 Mild
2 Moderate
3 Severe
Systemic disease: Pain tends to be intense.
ASSOCIATED SYMPTOMS
What other symptoms have you had that you can associate with this problem?
FUPs: Have you experienced any of the following?
• Blood in urine, stool, vomit, mucous • Cough • Difficulty swallowing/speaking
• Dizziness, fainting, blackouts • Dribbling or leaking urine • Memory loss
• Fever, chills, sweats [day or night| • Heart palpitations or fluttering • Confusion
• Nausea, vomiting, loss of appetite • Numbness or tingling • Sudden weakness

Systemic disease: Presence of symptoms bilaterally (e.g., edema, nail bed changes, bilateral weakness,
paresthesia, tingling, burning). Determine the frequency, duration, intensity, and
pattern of symptoms.
AGGRAVATING & RELIEVING FACTORS
What kinds of things affect the pain?
FUPs: What makes your pain/symptoms worse (e.g., eating, exercise, rest, specific positions,
excitement, stress)?
Relieving Factors
• Who makes it better?
Systemic disease: Unrelieved by change in position or by rest,
* How does rest affect the pain/symptoms?
FUPs: Are your symptoms aggravated or relieved by any activities?
If yes, what?
How has this problem affected your daily life at work or at home?
How has it affected your ability to care for yourself without assistance |e.g., dress, bathe, cook, drivel?
MEDICAL TREATMENT AND MEDICATIONS
What medical treatment have you had for this condition?
FUPs: Have you been treated by a physical therapist for this condition before? If yes:
When?
Where?
How long?
What helped?
What didn't help?
Was there any treatment that made your symptoms worse? If yes, please elaborate
MEDICATION
Are you taking any prescription or over-the-counter medications?
FUPs: If no, you may have to probe further regarding use of laxatives, aspirin etc. If yes:
What medication do you take?
How often
CURRENT LEVEL OF FITNESS
What is your present exercise level?
FUPs: What type of exercise or sports do you participate in?
Ask about frequency, duration, intensity
Dyspnea: Do you ever experience any shortness of breath (SOB) during any activities
FUPs: Are you ever short of breath without exercising?
• If yes, how often?
• When does this occur?
• Do you ever wake up at night and feel breathless? If yes, how often?
• When does this occur?
SLEEP-RELATED HISTORY
Can you get to sleep at night? If no, try to determine whether the reason is due to the sudden
decrease in activity
• Are you able to lie or sleep on the painful side?
If yes, the condition may be considered to be chronic, and treatment would be more vigorous than
If no, indicating a more acute condition that requires more conservative treatment.
• Are you ever wakened from a deep sleep by pain?
STRESS
What major life changes or stresses have you encountered that you would associate with your
injury/illness?
Alternate question: What situations in your life are "stressors" for you?
• On a scale from 0 to 10, with 0 being no stress and 10 being the most extreme stress you have
ever experienced, in general. what number rating would you give to your stress at this time in your
life?
» What number would you assign to your level of stress today?
FINAL QUESTION
Do you wish to tell me anything else about your injury, your health, or your present symptoms
that we have not discussed yet?
Alternate question: Is there anything else you think is important about your condition that we
haven't discussed yet?
HOSPITAL INPATIENT INFORMATION
Medical Record
Treatment of hospital or nursing home inpatients requires a slightly different interview (or
information- gathering) format. Reviewing the patient's medical record for information will assist
the therapist in developing a safe and effective plan of care.
Nursing Assessment
After reading the patient's chart, check with the nursing staff to determine the nursing assessment
of the individual patient.
Cooperation between nurses and therapists is an important part of the multidisciplinary approach
in planning the patient's plan of care.
THANK YOU