The Patient-Doctor Interview

The patient-doctor interview is one introduces both parties, identifies the problem or
the issue of the case, and focuses on the resolution of the patient's problem.

You function better as a professional in a setting which control. The patient should be
able to view the as a source of information and support, yet should not be intimidated
by a seemingly superior or higher figure. The partnership between you and the patient
should be an equal one. As the patient feels vulnerable during the consultation, feeling
intimidated or helpless will not help them feel capable of bettering their health. Aim
to motivate and encourage patients, so they are more likely to cooperate in their
treatment and management plan.

Because your meeting with the patient creates a critical for first impression of you,
your appearance and appearance of your office are the key points in getting the
interview off to a good start.

Your appearance should be professional and clean as cleanliness reduces the number
of disease-causing pathogens and inhibits their transmission to patients. You should
shower use deodorant, have fresh breath, keep your hair off your collar, have neat and
clear nails, wear appropriate clean clothing, and limit the jewellery to a wedding ring.
You must wash hands between patients.

You must consider the appearance of your office. You and the patient must feel
comfortable with the surroundings for the interview to be effective. If there is a large
desk between you are the patient and, this might be a barrier to open communication
between you. Placing yourself a superior position can intimidate the patient feel. A
computer screen can also be a barrier. Similarly, a doctor who does not maintain eye
contact with the patient, and focuses on the computer can appear uninterested and
uncaring. Sit at eye-level, and respond appropriately by imitating it posture. This
nonverbal gesture can make the patient feel more comfortable, and more of an equal.

The greeting between you and patient should be pleasant and you should state your
name and title. Address the patient by their name and should pronounce it properly.
Speak clearly and in an appropriate tone and volume. The patient should be able to
understand what you are saying. If the patient does not understand English, it is best
to get an interpreter or family friend to help.
Emotions
The patient will not open up to you unless they are certain that you can be trusted. you
must work hard to earn this trust, not only by maintaining confidentiality, but also by
treating the patient with respect. As trust in increases, it becomes easier for the patient
to share his ideas.

The patient must sense your care and toughest-looking patient will need empathy and
understanding. You can communicate this through facial expressions and care can be
reflected through your eyes or through a touch or handing of a tissue if the patient is
crying. Patient should feel unthreatened and safe and will easily express themselves.

Maintaining confidentiality is important and it is important for the doctor to be

genuine with the patient while giving honest and objective information without
judgment or blame not to say that you must not lie to the patient if you disapprove. If,
for example, the patient is doing something which will affect their health, you should
tell them this in a clear and a non-judgmental way.

The good doctor is an empathic soul and you should place yourself in your patients'
shoes and be aware of their situation and what they are experiencing. This shows
understanding and fairness towards patients, as well as a promise of support.

In assessing the patient's problems, once the initial relationship between you and the
patient has been established, the second part of the interview is for you to assess the
patient's problem. This requires you to be able to listen to and understand the
information presented to you.

Open-ended questions

To gain an accurate and complete understanding of the patient's problems, use open-
ended questions approach in the opening of the interview. This requires the patient to
derive their own answers through reasoning, rather than give a simple yes or no
response.

For example:

Doctor: What has brought you to the hospital today?

Or
 Doctor: How can I help you today?

Or

Doctor: What can I do for you today?

In contrast, closed-ended questions are as follows:

Doctor: Is the pain dull?

Or

Doctor: Does your stomach hurt?

Or

Doctor: Are you feeling ok now?

The open-ended questioning allows the patient to use their words to describe the
situation, experience and symptoms. Do not feed the patient your own vocabulary. Be
patient so the patient open up. Closed-ended questions elicits inaccurate responses and
leads to misunderstandings.

Open-ended questions allow you to see the situation through the patient's eyes and
you allows you to empathise. By listening to the patient's recount of the story, you can
identify the underlying issues as well as the presented problem.

After you have heard the complete situation, refer more direct questioning, to gain a
more specific diagnosis. For example:

Doctor: How can I help you today?

Patient: I've been getting awful stomach pains.

Doctor: Where is the pain?

Patient: It's just under my diaphragm.

 Doctor: Is the pain constant or does it come every now and then?

Patient: Constant.

The doctor could have used open questions to gain a more detailed and accurate
response. For example:

Doctor: Can you describe the pain?

Patient: I've been getting it for the past three weeks, and it's always there, and it
wakes me up at night sometimes. I noticed that I pass a lot of urine.

When experienced you can develop a hypothesis of the diagnosis from the first few
moments with the patient. This is due to pattern-recognition, where the symptoms and
experiences of the patient point to one specific illness. By allowing the patient to
describe the problem. This enable you to develop a diagnosis hypothesis,

Allowing the patient to express themselves through open-ended questioning will give
the doctor an insight into environment stresses that might have influenced the
problem.

For example:

Doctor: Can you tell me a bit more about your stomach pains?

Patient: Well like I said they started three weeks ago and seem to get worse when I
bend over to pick something up off the floor, or if I am sitting down for long periods
of time.

This information will help the doctor understand the possible environmental causes of
the symptoms.
Facilitation

Facilitative comments are important to encourage the patient to keep talking.

Comments such as:

* Please tell me more about the stomach pains

 * How would you describe the pain
* Can you describe that in more detail
* Go on

Facilitative noises uh-uh and hmm and nodding of the head, accomplishes the same
goal. Silence while listening to the patient can also be an indication that the patient
should keep talking. Repeating the last few words which the patient has said is also a
way of encouraging the patient to keep talking.

Most doctors do not utilise facilitation enough. And it is easy to get trapped in the
closed-ended questioning method, especially if you have already formed a diagnosis
without hearing all the details of the patient's story. Nondirective facilitations should
be used to encourage the patient to tell the story in their own words.

For example:

Doctor: Can you tell me more about the stomach pains?

Patient: They get worse when I bend over to pick something up or when I am
sitting for long periods of time.

Doctor: So they are worse when you sit down for long?

Patient: Well I guess they are also pretty bad if I walk quickly or move suddenly.

Doctor: Ok. (silence)

Patient: This stomach ache has now gone on for three weeks, I'm having trouble
eating and sleeping, and my sex life is rapidly deteriorating.

Clarifying and Validating

It is important that the doctor understands the problem accurately, so that he is able to
derive the correct diagnosis. If he does not understand the patient clearly, he must ask
for the message to be clarified:

Doctor: I am not sure that I understand.

 Or

Doctor: Can you please clarify what you mean.

Or

Doctor: What do you mean?

This is especially important when there are language difficulties, where the patient
can not understand the questions properly or is unsure how to communicate the
message. For the message to be received accurately, both parties must understand it in
the same way.
Barriers to Effective Communication:

We have previously discussed physical barriers in the consulting room so we will. Let
us now consider how doctors can create barriers between them and their patients.

For example:

* Moralising or judging
* Giving advice or suggestions
* Approval or disapproval
* Raising the tone
* Accusing
* Threatening
* Discriminating
* Asking for explanations
* Ignoring the patient's concerns

One or more of these barriers can affect the doctor and the patient's relationship.