Introduction to Interviewing
A patient-centered interview serves three equally important functions and specific communication skills can be used to accomplish each of its goals. You may already use some of these communication techniques in routine conversation, but many are specific to the medical context. This chapter provides a broad overview of each function of the medical interview, and subsequent chapters provide more detailed descriptions of the content and process of patient-provider communication.
Function #1. Build a therapeutic relationship
Patient-centeredness can be defined as “(1) eliciting and understanding patient perspectives (concerns, ideas, expectations, needs, feelings, and functioning), (2) understanding the patient within his or her unique psychosocial and cultural contexts, and (3) reaching a shared understanding of patient problems and the treatments that are concordant with patient values.”1
A trusting relationship is at the heart of patient-centered care, encouraging collaboration and respect for an individual’s preferences, values, and culture. Research shows that a patient-centered approach increases patients’ satisfaction with their care, boosts treatment adherence, and improves health outcomes, from diabetes control to cancer mortality. Research also shows that physicians’ with a positive attitude toward patient–centered care are much more likely to involve patients in medical decisions.
Your relationship with a patient begins the moment you enter the room, when you make eye contact, share a warm greeting, and show interest in them as a person. The rapport established in the first minute will continue to be built from there.
Function #2. Gather information
Skilled physicians make most new diagnoses based on the patient’s history, even in today’s era of advanced imaging and labs. Effective data gathering will help you diagnose new problems efficiently and accurately and allow you to optimize treatment of existing conditions.
The amount and type of history gathered differs for different encounters. At the time of admission to the hospital or at a new patient appointment in the clinic, a clinician may perform a comprehensive history to identify, prioritize, and address all important issues. At a follow-up or problem focused clinic visit, the data gathered is much more limited.
A truly ‘complete’ interview, encompassing all possible questions about health, would take hours and is rarely done. Instead, a primary care physician may gather information over time, starting with the questions most relevant for each individual patient, and creating a more and more complete picture over months and years.
| Content of the Medical Interview: History for Immersion & Hospital Tutorials | |
|---|---|
| History of present illness | A complete characterization of your patient’s chief concern
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| Past medical history |
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| Medication history |
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| Health behavior history |
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| Family history |
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| Social history |
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| Review of symptoms |
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Function #3. Negotiate a Treatment Plan
The third function of the interview is to develop a treatment plan guided by both the medical evidence and the patient’s goals and preferences. The physician provides information in an understandable way and includes the patient and family in choices and decisions, a process known as shared decision making.
In hospital tutorials, we are not part of our patients’ care teams so we will not discuss their treatment plans. Starting in January, in your Primary Care Practicum, you’ll observe as your preceptor negotiates an appropriate plan for their patients. Eventually, you’ll practice this critical skill yourself.
A Framework for Communication and Interviewing
The Calgary Cambridge model, developed by Kurtz and Silverman, integrates the process and content of the medical interview. We have adapted this framework for our FCM curriculum, and will return to it as you build skills for each stage of the clinical encounter. In Immersion, we will focus on the content of the interview and on process skills for starting the encounter and gathering information.
The interactive graphic below, adapted from Calgary-Cambridge, is the toolkit of communication skills and techniques you will develop over the course of FCM.
Template for content of the interview
Former FCM students created this template for note taking during a patient interview. For the first few tutorials, you may want to use it (on paper or a tablet) to guide your interview and jot a few notes. Be judicious, though – taking too many notes is one of the most common challenges for early students – constantly looking down at your notes can break eye contact and rapport and make the interview flow less smoothly.
Resources and References
Epstein RM and Street RL (2011). The Values and Value of Patient Centered Care. Annals of Family Medicine 9(2):100-103. LINK
Street RL, Makoul G et al (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling. 74(3):295-301 LINK
Ahmed, A., van den Muijsenbergh, M. E. T. C., & Vrijhoef, H. J. M. (2022). Person-centered care in primary care: What works for whom, how and in what circumstances?. Health & social care in the community, 30(6) LINK
King A, Hoppe RB. “Best practice” for patient-centered communication: a narrative review. (2013) Journal of Graduate Medical Education. 5(3):385-393. LINK
Wang, D., Liu, C., & Zhang, X. (2020). Do Physicians’ Attitudes towards Patient-Centered Communication Promote Physicians’ Intention and Behavior of Involving Patients in Medical Decisions?. International journal of environmental research and public health. LINK
Kurtz S, Draper J and Silverman J. (2005) The ‘what’: defining what we are trying to teach and learn. Chapter 2, Teaching and Learning Communication Skills in Medicine. CRC Press, London, England.