INTRODUCTION TO

CLINICAL MEDICINE
– PART II
Altered by: Dr. Shakel Henson
Date: 26th September, 2022.
OBJECTIVES
 Be knowledgeable of interviewing techniques

 Learn the art of various communication skills

 Apply these communication skills in history

taking
INTERVIEWING MILESTONES
♦ GETTING READY: The Approach to the interview

♦ LEARNING ABOUT THE PATIENT: The sequence of the

interview

♦ BUILDING THE RELATIONSHIP: The techniques of skilled

interviewing

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INTERVIEWING MILESTONES
♦ ADAPTING THE INTERVIEW TO SPECIFIC
SITUATIONS

♦ SENSITIVE TOPICS THAT CALL FOR SPECIAL

SKILLS

♦ SOCIETAL ASPECTS OF INTERVIEWING

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GETTING READY
▪ interview requires planning

▪ goals must be clearly set before the interview

▪ do a self-reflection
- our expectations + reactions during the
interview may affect what we hear + how we behave

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GETTING READY

▪ be sensitive what messages we send to our patient,

i.e. our words or how we behave,
all convey interest, attention, acceptance and
understanding

▪ personal appearance is important – patient’s find it

reassuring to see us appropriately dressed,
neat/clean and wearing our name tags

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 GETTING READY

▪ keep the environment as private

and as comfortable as possible

▪ distance between you and the

patient should facilitate
conversation

▪ sit at eye level with the

patient

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GETTING READY

▪ review of patient’s medical record/chart –

- to gather information

- to help consider ideas or approaches

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LEARNING ABOUT THE PATIENT
A. GREETINGS
♦ greet the patient by name
▪ use a formal title to address the patient

▪ avoid first names

▪ ask the patient how she/he wants to be

addressed

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LEARNING ABOUT THE PATIENT

▪ avoid addressing an unfamiliar adult “granny” or

“dear”

▪ make sure to ask the patient how to pronounce

her/his name if you are unsure of the
pronunciation

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 LEARNING ABOUT THE PATIENT
♦ introduce yourself

♦ shake hands (if possible)

♦state your role/how you

will be involved in the
patient’s case

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LEARNING ABOUT THE PATIENT

Ex. “ Good morning Mr. James Bond. I am

Jane Doe, a 1st term medical student of the
American University of St. Vincent School of
Medicine.

I am here to ask you a few questions as to

why you are here today. Will that be ok with
you?”

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LEARNING ABOUT THE PATIENT
♦ acknowledge/greet any other person that is with
the patient

♦ be attuned to patient’s comfort

▪ ask how she/he feels and attend to it first
▪ ask if your patient has been waiting for a long
time (office)
▪ ask if it’s the convenient time for the visit (hosp)

♦ maintain patient’s confidentiality

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LEARNING ABOUT THE PATIENT
B. PATIENT’ S DATA
Name
Age/Date of birth
Address
Occupation
Race
Religion

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LEARNING ABOUT THE PATIENT

C. PATIENT’S STORY
▪ identify the patient’s agenda (concern)

ex. “So please tell me why you have

come to see me today?”

“What can I do for you today?”

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LEARNING ABOUT THE PATIENT
D. EXPAND/CLARIFY THE PATIENT’S
STORY
▪ start by asking open-ended questions
▪ vary your request ex. “Tell me more”
“Anything else?”
▪ KISS (Keep It Short and Simple)

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LEARNING ABOUT THE PATIENT
▪ ask directive questions (what, when,
where, how)

▪ ask closed questions (“yes” or “no”)

▪ avoid leading questions which are negatively

phrased
ex. “You don’t get chest pains, do you?”

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LEARNING ABOUT THE PATIENT
▪ pursue the seven (7) attributes of a symptom
OLDCARTS
Onset
Location
Duration
Character
Aggravating/Alleviating factor
Radiation
Timing
Symptoms (other)

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LEARNING ABOUT THE PATIENT
OPQRSTU
Onset
Palliating/Provoking factors
Quality
Radiation
Site
Timing
Useful other symptoms

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LEARNING ABOUT THE PATIENT
▪ establish the sequence of events and time
course of the patient’s symptoms

▪ follow the patient’s lead

▪ listen without interrupting

▪ avoid medical jargon ex. dyspnea

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LEARNING ABOUT THE PATIENT
- CREATE A SHARED UNDERSTANDING
OF THE PROBLEM

- GENERATE + TEST DIAGNOSTIC HYPOTHESES

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LEARNING ABOUT THE PATIENT

- NEGOTIATE A PLAN

- PLAN A FOLLOW –UP

- CLOSE THE INTERVIEW

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TECHNIQUES OF SKILLED
INTERVIEWING
 Active listening
 Echoing
 Eye contact
 Empathy
 Posture
 Validation
 Questioning
 Summation
 Continuers
 Transition
 Mirroring
ACTIVE LISTENING
▪ paying attention to
what the patient is

communicating

▪ being aware of the

patient’s emotional
state
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EYE CONTACT
▪ indicates that you are interested in your
patient’s story

▪ judge when + how much is socially +

professionally appropriate

▪ be aware that in some cultures it may be

offensive to stare

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POSTURE
▪ open body posture
- leaning slightly forward with arms
apart + hands on the knees or hands on your
lap conveys a message that you are listening
+ open to the patient’s concerns

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QUESTIONING
▪ start with open-ended questions
ex. “So please tell me what brings you in
today?”

▪ focused (specific) questions

ex. “Tell me more about the chest pain.”

▪ directive questions (what, when, where, how)

ex.. “What makes the pain worse?”

▪ close-ended questions (“yes” or “no”)

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▪ ask one question at a time

▪ keep it short and simple

▪ offer multiple choice answers

ex. “ Which of the following words best
describes your pain – sharp, dull, shooting?”

▪ request clarification
ex. “Doctor, she was taken in.”
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CONTINUERS
▪ using gestures
ex. nodding, rolling of the hands

▪ using words or phrases

ex. “Go on” or “I’m listening”

▪ tells your patient that you are listening and

wish him/her to continue

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MIRRORING
▪ mimicking/following
the patient’s body
posture, position,
gestures

▪ increases sense of
connectedness

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ECHOING
▪ repeating the patient’s last words

▪ verbal equivalent of mirroring

Ex. P: “The pain is getting worst.”
D: “Getting worst?”

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EMPATHY
▪ first identify the patient’s feeling then,
respond with understanding + acceptance
ex. “I understand it’s really frustrating…”

▪ requires willingness + interest on your part

in hearing + eliciting the emotional content

▪ may also be non-verbal:

- offering a tissue paper
- gently placing your hand on the
patient’s arm
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VALIDATION
▪ closely related to empathy

▪ telling the patient that you

acknowledge/accept their experience +
that their response is appropriate +
understandable

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SUMMARIZATION/SUMMATION

a.) tells the patient that you are carefully

listening

b.) allows you to identify gaps in the history

c.) helps the patient remember further

relevant details when they hear their story
repeated back to them

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d.) useful technique to use when you can’t
think what to ask the patient next

Ex. “If I can just take a moment to recap

what you’ve told me so far…
is there anything else?

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TRANSITION
▪ telling the patient when you are changing
directions during the interview

▪ it should be explicit
- make clear what the patient should
expect or do next

Ex. “Now I’m going to ask you about your past

medical history.”

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