Introduction to Clinical Interviewing Flashcards
______ is established during the clinical interview, as are mutual expectations.
_________ factors are often more important to patients than technical expertise
Doctors must learn to be _________ & take care not to use their patients, consciously or unconsciously, to gratify their own needs
rapport
interpersonal factors
self-observant
What is the Biopsychosocial Model?
- George Engel (1977)
- More integrated way of looking at patients, diseases, symptoms & behaviors
- Widely accepted but increasing distant from real world medicine
Definitions
- Biological System
- Psychological System
- Social System
- Biological system – patient’s anatomical & molecular substrates of disease
- Psychological system – patient’s psychodynamic factors, motivations & personality in relation to their illness
- Social system – includes environmental, cultural & familial influences on the patient’s experience & expression of illness
________ is increasingly becoming accepted as part of the BPS model.
Spirituality
What are the 4 models of Doctor-Patient Interaction?
Which one is the most ideal?
-
Paternalistic
- “Autocratic”, “doctor-knows-best”
- Can be desirable (ex: emergencies)
- Preferred by many doctors & some patients
-
Informative
- Doctor dispenses accurate information, but choices are left to patient
- Preferred by many patients, but often difficult for doctors
-
Interpretative
- Doctor knows patient & his/her situation & values well
- Seeks to share decision-making responsibilities
- Often ideal, but requires more time & intimate knowledge of the patient
-
Deliberative
- Doctor acts as an ally who actively advocates a particular course of action (ex: weight loss, smoking cessation)
What is Transference?
- Unconscious process
- Patient attributes to the doctor aspects of important past relationships
- Especially early/parental relationships
- Patients may unconsciously transfer residual feelings from early relationships (usually w/ parental/authority figures) to doctors
- Unexpected, exaggerated, often disruptive rxns
- Transference can be **positive, negative or both/unstable **
What is Countertransference?
Doctor attributes to the patient aspects of important past relationships
What are the 3 basic functions of effective interviewing?
- Determining the nature of the problem
- Developing & maintaining a therapeutic relationship
- Communicating information & implementing a treatment plan
What are the additional goals of psychiatric interviews?
- Recognizing the psychological determinants of the patient’s rxns & behaviors
- Symptom classification leading to diagnosis
What are the 6 strategies of establishing rapport?
- Putting patient & interviewer at ease
- Finding patient’s pain & expressing concern
- Evaluating patient’s insight & becoming an ally
- Showing expertise
- Establishing authority or a physician or therapist
- Balancing the roles of empathic listening, expert & authority
Some basic tips for beginning an interview
- Know the patient’s name
- Introduce yourself & your role
- Tell the patient what you will do & why
- Provide the opportunity to have others present or speak in private
- Use desk/table for notes
- Set up the interview accordingly if you feel at risk
- Don’t talk down to your patients
What is the difference between an interview content vs. process?
- Content – literally what is said
-
Process – what is happening non-verbally
- Unspoken or unconscious feelings & rxns
- Process is very important in interviews where emotional factors are prominent
- Psychiatric illnesses
- Serious, painful, stigmatizing or debilitating diseases
What are some effective interview techniques? (17)
- good rapport
- open-ended questions early on
- closed-ended questions later on
- facilitation
- reflection
- clarification
- silence
- interpretation
- confrontation
- summation
- explanation
- transition
- positive reinforcement
- self-revelation
- reassurance
- advice
- ending the interview
Open-ended vs. Closed-ended Questions
Definitions
When to use & why
“Open-ended” questions are often helpful in building rapport
- Use open-ended questions FIRST
- Use closed-ended questions later on to establish diagnosis
-
Open-ended questions
- Invite patients to talk about whatever they feel is important (elaborate)
- Less time-efficient & less precise
- More effective at getting to the “real” problem when the presenting complaint can’t be taken at face value
-
Closed-ended questions
- Encourage patients to respond to what is asked & no more
Refers to various means of verbal & non-verbal communication that encourage the patient to continue telling his/her story
Facilitation
