Use of the interviewing techniques such as reflection, legitimation , support,

partnership, respect, empathy, unconditional positive regard, avoidance of sham,eand

huMiliation and nonverbal skills contribute to interview efficiency and to rapport,
Examples
Reflection: "You seem to be very upset about this issue."
Legitimation: "1 can certainly understand why taking medications is so difficult
for you."
Support: "I want you to know that I am here to help you through this difficult
decision."
Partnership: "Then how would you like to be helped now ?"
Respect: "it is really nice to sec you coming to the clinic on your own, despite how
difficult it is for you."
Empathy: "1 understand your suffering."
Unconditional positive regard: "I admire how you keep trying."
Avoidance of shame and humiliation: "How could you forget that ?"
Nonverbal skills: touch, positive eye contact.
To maintain rapport, the physician needs to handle the patient's emotions appropriately.
Throughout the interview, the physician should remain aware of and responsive to
emotions when they become apiltent and when they ought to be present but are not.
Part of history taking involves sharing control and decision making. This "activates" the
patient as an agent of his or her own care and has been shown to improve biologic outcome.
Patients who feel understood by their physicians are generally more satisfied and feel
better, which in turn brings more satisfaction to the physician.
Use of the simple skills (examples listed below) influences adierence to treatment
recommendations :
1)"Would you tell me your understanding of diabetes and its causes ? " (this means

establishing baseline knowledge and attributions);

2)"You have a positive PPD (purified protein defivative): this means that the "germs"
of tuberculosis entered your body, went to your lungs and feel asleep. You do not have
tuberculosis." (avoidance of the complex medical terminology);
3)"Just to make sure that I have made myself clear, can you tell me how you will be

taking the medications at home?" (checking).

Patierts will better understand the nature of their illness, the suggested diagnostic
prOCe&res, and the treatment possibilities.
Unless physician and patient negotiate agreement regarding the nature of the problem,
the patient will not comply.
After the patient fully understands the disease process, the physician and patient can
achieve an alliance for the patient's care , . ) information provided to the patient should be
brief. It is important to remember thaty_ixiety interferes with the ability to understand the
are first told about an illness.
illness and most patients are quite1anxibu,s
when

, ;they
>'.7
Irutiaily, the physician should stick to a few key points.
The Structural Elements of the Interview

T)

Careful structuring of the interview is central to Wfgetivieness. Each of the 10 structural

elements
must be used. They are
)
1.optimizing the environment ,.

2.

the opening ;