Download Effective Communication and Interviewing Skills

Seidel n Ball n Dains n Flynn n Solomon n Stewart
Effective
Communication and
Interviewing Skills
Total running time: 19:43
Overview
This program shows how to build an accurate and
thorough history and develop a partnership with the
patient. Because each patient has individual needs,
it provides examples of effective communication
and interviewing skills that may be used for different patients. After describing how to prepare the
setting and yourself for the history, the first part of
the program shows how one examiner uses effective
communication skills to gather information from
a patient with a headache. Then using the same
examiner, patient, and symptom, this program
demonstrates how ineffective communication skills
uncover much less information.
In the second part of the program, an examiner
uses effective communication skills to obtain a history
from a patient with abdominal pain. To contrast, the
same examiner then uses ineffective communication
skills with the same patient with dramatically different results.
Learning Objectives
After viewing the Effective Communication and Interviewing Skills program and reviewing the textbook
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Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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chapter “Partnership with Patients: Building a History,”
the learner should be able to:
1.Describe how to prepare the setting for effective
communication.
2.Discuss ways to prepare yourself for effective
communication.
3.Identify appropriate questions for different patients
based on their chief complaint.
4.Explain ways to enhance patient responses.
5.List techniques for overcoming communication
barriers.
6.Describe how to address issues that are sensitive
for the patient.
7.Identify techniques to avoid when interviewing a
patient and building a health history.
Discussion Topics
1.Application of ethical principles to the health history interview
2.When to use different types of questions, such as
open-ended and closed-ended (direct) questions
3.When to use different techniques to enhance
patient responses, such as facilitation, reflection,
and clarification
4.How to overcome barriers to communication
5.Methods for building the history in partnership
with the patient
6.Tools and techniques for assessing alcohol and
substance abuse, intimate partner violence, sexuality and safe sex practices, and other sensitive
issues
7.Ways to adapt the interview for patients of different ages, frail patients, and those with physical or
cognitive disabilities
Program Outline
I.Introduction
II.Preparing for the interview
A.Setting
B.Structure of history
C.Self
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Effective Communication and Interviewing Skills
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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III.Building a history: Headache
A.Effective communication, including use
of OLD CARTS mnemonic and CAGE
questionnaire
B.Ineffective communication, including
use of OLD CARTS mnemonic and CAGE
questionnaire
IV.Building a history: Abdominal pain
A.Effective communication, including use of
PQRST and HITS mnemonics
B.Ineffective communication, including use
of PQRST mnemonic and brief screening for
domestic violence
V.Summary
Review Questions
1.To foster communication, the setting should have:
a.Comfortable seats for you and the patient only.
b.A lively, stimulating atmosphere with good
lighting.
c.A desk conveniently placed between you and
the patient.
d.A clock where you can see it, such as behind the
patient.
2.Which item is not typically part of the health history?
a.Family history
b.Chief complaint
c.Review of systems
d.Record of job performance
3.When you first meet a patient named Arthur J.
Chambers, how should you address him?
a.Sir
b.A.J.
c.Arthur
d.Mr. Chambers
4.To investigate a patient’s chief complaint, you
should begin with which type of questions?
a.Leading
b.Clarifying
c.Open-ended
d.Closed-ended (direct)
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Effective Communication and Interviewing Skills
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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5.When enhancing patient responses, the
examiner would demonstrate interpretation by
saying:
a.“I’m sorry to hear that.”
b.“Can you tell me more about that?”
c.“What do you mean when you say
‘disturbing’?”
d.“The pain radiates from your stomach to your
back.”
6.Which mnemonic helps guide the assessment of
a symptom?
a.HITS
b.FICA
c.TACE
d.PQRST
7.In the CAGE questionnaire, the A indicates:
a.Alcohol.
b.Annoyed.
c.Associated factors.
d.Aggravating factors.
8.If you and your patient do not speak the same
language, which of these people is the best
choice for an interpreter?
a.The patient’s spouse
b.A friend of the patient
c.A professional interpreter
d.A blood relative of the patient
9.If a patient cries during the interview, what
should you do?
a.Leave the room.
b.Pose leading questions.
c.Move on to the next question.
d.Offer tissues and a moment of silence.
10.In the HITS mnemonic, the S indicates:
a.Stab.
b.Scream.
c.Severity.
d.Screening.
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Effective Communication and Interviewing Skills
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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11.Which of the following is an example of clarification to enhance patient responses?
a.“I understand how you feel.”
b.“That behavior is unacceptable in this office.”
c.“Of all these things, what concerns you the
most?”
d.“How have you been feeling since your last
visit?”
12.If the patient becomes silent during the interview,
what should you do?
a.Talk about your own experiences.
b.Change the subject to a neutral one.
c.Probe to get at the root of the problem.
d.Allow silence within reasonable bounds.
Answers to Review Questions
1.d.To foster communication, the setting should
have a clock where you can easily see it, such
as behind the patient. It should also have
comfortable seats for you, the patient, and
anyone else present; a private, quiet atmosphere with good lighting; and minimal furniture between you and the patient.
2.d.The health history does not typically include
the patient’s record of job performance,
although it may include questions about the
work history as it relates to health risks and
occupational exposure. The health history
includes identifiers, chief complaint, history
of present illness or problem, past medical
history, family history, personal and social history, and review of systems.
3.d.You should always formally address a patient,
such as Mr. Chambers, when you first meet the
patient. Then if the patient requests it, you
may use a more casual form of address, such
as A.J. or Arthur. Although Sir is a form of formal address, it is impersonal and not preferred.
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Effective Communication and Interviewing Skills
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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4.c.When investigating the chief complaint,
begin with open-ended questions to encourage
the patient to answer as fully as desired and
without interruption. Avoid leading questions
because they can limit information to only
what the patient thinks you want to know.
Use clarifying questions to find out what the
patient means by a particular response. Use
closed-ended (direct) questions later to obtain
specific information.
5.d.Interpretation involves repeating what you
have heard to confirm the patient’s meaning.
“I’m sorry to hear that” is an example of empathizing. “Can you tell me more about that?”
demonstrates facilitation. “What do you mean
when you say ‘disturbing’?” uses clarification
to enhance the patient’s response.
6.d.The PQRST and OLD CARTS mnemonics
help guide the assessment of a present illness
or symptom. HITS guides the assessment of
domestic violence, FICA helps reveal spiritual
concerns, and TACE aids in evaluating alcohol
use.
7.b.In the CAGE questionnaire, C indicates cut
down, A signifies annoyed, G indicates guilty,
and E means eye-opener. Although the CAGE
questionnaire assesses alcohol use, alcohol is
not part of the mnemonic. Associated factors
and aggravating factors are part of the OLD
CARTS mnemonic.
8.c.When an interpreter is required, a professional
interpreter is preferred to ensure confidentiality and accuracy. Using a family member or
other person to interpret may be a barrier to
candid conversation. It also breaches confidentiality and provides no assurance that the
interpretation is correct.
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Effective Communication and Interviewing Skills
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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9.d.If crying occurs during the interview, you
should be silent and let the moment pass at the
patient’s pace. As needed, give permission and
offer tissues. Such techniques as leaving the
room, posing leading questions, and moving
on to the next question do not display compassion, could prematurely stop the patient’s
crying, and interfere with rapport-building.
10.b.In the HITS mnemonic for assessing domestic
violence, H indicates hurt, I means insult,
T signifies threaten, and S means scream.
Severity is part of the PQRST and OLD CARTS
mnemonics. Stab and screening are not part of
this domestic violence assessment.
11.c.Clarification helps divulge what the patient
means, such as with the question, “Of all
these things, what concerns you the most?” “I
understand how you feel” demonstrates empathy. “That behavior is unacceptable in this
office” is an example of confrontation. “How
have you been feeling since your last visit?”
is an open-ended question that is best used at
the beginning of the history.
12.d.If the patient becomes silent during the
interview, respect the silence and be comfortable with it, but give it reasonable bounds.
The other answer options are not appropriate
responses to silence. If asked, you may talk
about aspects of your experiences. You may
later probe to investigate a problem, but you
should not push too hard when the patient is
silent.
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Effective Communication and Interviewing Skills
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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Copyright © 2010, 2006, 1994 by Mosby, Inc.,
an affiliate of Elsevier, Inc. All rights reserved.
All rights reserved. No part of this publication may be reproduced or
transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher.
Mosby items and derived items © 2010, 2006, 2003, 1999, 1995, 1991, 1987 by Mosby, Inc.
an affiliate of Elsevier Inc.
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