Medical Interviewing I: The Basics

Question 1

describe nonverbal (data gathering technique)

Answer 1

head-nodding and silence

Question 2

describe checking (data gathering technique)

Answer 2

reviewing/repeating to ensure accuracy

Question 3

describe clarification (data gathering technique)

Answer 3

asking the patient to restate or give examples

Question 4

describe interruption (data gathering technique)

Answer 4

redirecting the patient they are rambling/tangential; restructuring the conversation

Question 5

describe transition (data gathering technique)

Answer 5

politely changing topics to gather relevant information

Question 6

describe reflection (data gathering technique)

Answer 6

paraphrasing to show attention/understanding

Question 7

describe information sharing (data gathering technique)

Answer 7

interpretations, explanations, expectations for outcomes

Question 8

describe giving directions (data gathering technique)

Answer 8

assigning responsibility for tasks

Question 9

describe define the problem (step 1 in clinical decision-making)

Answer 9

• take into account referral question and chief complaint
• internal problem list: signs, symptoms, history
• develop hypotheses that can be tested by info from problem list
• iterative process of refining hypotheses based on new info.

Question 10

describe define outcome goals (step 2 in clinical decision-making)

Answer 10

• what is the desired health condition at conclusion of treatment?
• the stage of illness will inform treatment goals
  
  • prevention/early intervention at early stages
  • methods for managing complex treatment regimen at mid-stages
  • family decisions, hospice care at late stages
• provider and patient negotiate achievable goals
  
  • weekly exercise regimen
  • dietary changes
  • family therapy to reduce stress at home

Question 11

describe generate alternative treatment solutions (step 3 in clinical decision-making)

Answer 11

• treatment interventions must consider how to:
  
  • alter biological functioning
  • modify behavior and cognition
  • facilitate changes in the environment
  • utilize social resources

Question 12

describe finalize treatment plan (step 4 in clinical decision-making)

Answer 12

• finalize treatment plan
  
  • select optimal interventions
  • prioritize interventions
  • keep goals clear, focused and achievable
  • confirm patient’s and patient’s family members’ understanding and commitment to plan
  • provide oral and written communication

Question 13

describe implement treatment plan (step 5 in clinical decision-making)

Answer 13

• implement treatment plan
  
  • establish method for communicating unexpected obstacles to implementation (i.e. side effects, insurance denial, family resistance)
  • set a follow-up appointment with expectation that progress will be reviewed

Question 14

describe evaluate the outcome (step 6 in clinical decision-making)

Answer 14

• evaluate the outcome
  
  • are symptoms resolved/reduced?
  • establish outcome criteria (i.e. lower scores on depression/anxiety measures, changes on lab reports)
  • in the case of diseases without a cure, positive outcomes can include symptom reduction and maintenance of good quality of life in spite of disease

Question 15

describe sources of error in decision-making

Answer 15

• theoretical and personal biases
• forced categorization
• over-optimism or pessimism
• too many hypotheses (use rule-outs)
• oversimplification
• normalizing abnormalities
• letting attitudes towards patient influence judgement
• mistaking correlation for causation

Question 16

describe medical interviewing of children and adolescents

Answer 16

• avoid open-ended questions
• seek collateral information from parents, teachers, caregivers
• use pictures, toys to elicit info.
• maintain non-judgemental attitude with adolescents