1. Introduction to the Clinical Interview
Susan Bentley, D.O.
5/9/2019

2. Introduction Patient –centered communication
Participatory interview style
Results:
Improved patient outcomes
Increased satisfaction with care
Decrease in overall costs
5/9/2019

3. Facilitating Patient Agenda
Overview
Elements of the patient-centered interview
Building Rapport
Listening Actively
Facilitating Patient Agenda
Dealing with Emotions
Managing Information
Finding Common Ground
5/9/2019

4. “A successful dialogue between patient and physician is at the heart of working scientifically with patients…”
G. L. Engel, 1995
5/9/2019

5. Building Rapport Establish Tone of Interview Set Direction
Transition from Social to Medical
5/9/2019

6. Facilitating the Patient’s Agenda
Encourage patient to communicate their medical story in their own terms
More accurate diagnosis and more effective time management
Includes verbal and non-verbal skills
5/9/2019

7. Case vignette… 59 year old woman in your practice 5 years
Irregular visits for hypertension
CC  urinary tract infection
Physical findings
Mild obesity
BP  160 / 92 mm Hg
UA +glucose, -protein, ketones, leukocyte esterase
Blood glucose  204 mg/dL
Clinical interaction
5/9/2019

8. Missed Opportunities
Building Rapport – “What has been going on in your life?”
Facilitating Agenda – “What are you concerned about?”
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9. Managing Information Questioning skills: Goal Open ended questions
Closed ended questions
Goal
Balance
Patient perspective
Specific information
5/9/2019

10. Active Listening
Recognition of clues to patients thoughts, unstated concerns, expectations
Patient personality affects communications style
“Oh by the way…”
Reluctance to accept recommendations
Strategies
Reflective listening
Exploring clues for meaning
Question to elicit patient’s perspective
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11. Case vignette…
67 year old man, new to practice, transferred care – dissatisfied with former doctor
CC  physical exam
Clinical interaction
“Follows” his diet
“Could do better” taking meds (some anxiety)
Reinforce compliance, write Rx, schedule follow-up in 3 months
Patient never shows up again
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12. Getting to the issues
Active listening  insight into why glucose is not controlled
Open-ended Questions  patient has no concept of medical nutrition therapy
Non-verbal cues  exploration of discomfort leads to understanding patient fears
5/9/2019

13. Dealing with Emotions
Visits to doctors can be emotionally charged (white coat syndrome)
Patient focus is physical complaints versus emotional distress
Explore patient feelings & respond appropriately to emotions
Develop treatment for the whole person
5/9/2019

14. Strategies for Exploration
Silence
Non-verbal encouragement
Neutral utterances, continuers
Reflection, echoing
Open-ended requests
Summary or paraphrase
Direct questions about feelings
Forming hypotheses together
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15. Strategies for Effective Responses
Naming
Understanding
Respecting
Supporting
Normalizing
Non-verbal behaviors
Exploring meaning behind expressions
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16. Finding Common Ground Shared vision of health
Reconciling patient and physician expectations
Strategies
Restate patient perspective
Explain clinical diagnosis, treatment plan
Check with patient on feasibility
Respectfully note different perspectives
Identify patient’s readiness to change
Brainstorm potential solutions, compromise
Reframe situation
5/9/2019

17. Case Vignette … 52 year old woman in your practice 6 years,
Frustrating non-compliance
CC  Type 2 diabetes, hypertension, hyperlipidemia
Physical findings
Mild obesity
Poor glucose control with increasing insulin dosage (glycosylated hemoglobin 10%)
Clinical interaction
Physician frustrated,
Decides to change approach
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18. Negotiating “Win-Win” solution
Explore emotional presentation of anger
Acknowledge her distress (Naming)
Normalize patient frustration
Explore patient goals for treatment plans
Establish common ground
Set reasonable treatment goals
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19. Conclusions Patient – centered communication has proven effective in
Improved patient outcomes
Increased satisfaction with care
Decrease in overall costs
Involves patients in decision-making process
Engaging patient in care improves compliance
Improved interview skills enhances experience for both physician and patient
5/9/2019

20. Where to Get More Information
Remaining lectures
Small group sessions
Assigned reading
Experience practicing these principles (try it, you’ll like it!)
5/9/2019

21. The Beginning …
5/9/2019