The medical interview is one of the most prized arts to practice and learn; a crucial part of being a doctor. It is a valuable tool for both gathering information and building a trusting, strong relationship with your patient. This blog post will focus on the points most important to keep in mind during a medical interview.
Yes, I did call a medical interview an art. A well-done interview is truly beautiful. During my intern years, I would jitter and scratch my head trying to remember what question to ask next or how to structure my medical interview. But thankfully, I’ve found a solution. These tips help me remember what to ask and what to do in these times.
The Tips discussed will be as follows:
Tip # 1: Introduce yourself and lead the conversation.
Tip # 2: Ensure your patient’s privacy is respected.
Tip # 3: Build a relationship with your patient.
Tip # 4: Understand and explore the patient’s thoughts and perspective.
Tip # 5: Use easy, understandable language, and clarify any points that need clarification.
Tip # 6: Provide structure to your medical interview.
Tip # 7 : Ask “OPQRST-AAA”.
Tip # 8: Incorporate the pathophysiology of the disease in question
Tip # 9: Ensure you cover all parts of the interview
Tip # 10: Use the correct type of questions at the appropriate time.
Tip # 11: Summarize!
First things first, you walk in and greet your patient with something along the lines of “Hello! Good afternoon! I am Dr. X, I’ll be the physician taking care of you today”. Your patient clearly knows who you are and you’ve set the tone of the meeting. The patient must know who you are and what this medical interview will comprise. Are you there to help diagnose them? Or maybe you’re there to explain a certain treatment? Clarify! Always identify the patient before walking in and then you’re set.
Although you might be tempted to let the patient lead the conversation by telling you what is wrong and how they’ve progressed. Starting and taking hold of the reins of the conversation is crucial. You want to guide the patient in this conversation while maintaining their perspective.
Take, for example, a patient telling you about their back pain; they go on and on about how they survived with it, albeit painfully, over a hundred situations. You could have saved a lot of time by asking what was wrong and then asking about the onset and how it progressed. You get the information you need without going through all those stories!
Remember, that does not mean that you shouldn’t allow the patient to talk freely. Sometimes the stories are the keys to diagnosis.
Is there anyone in the room that the patient might not feel comfortable speaking in front of? Make sure the patient has complete privacy to speak about all the things bugging them. Even if it is their mom, dad, partner, whoever it is; the patient might not want to speak in front of them. Ask them if the patient would like to continue on their own and if they agree, politely ask them to leave the room.
This also applies to you: never indulge in your patient’s case unless they gave you consent to do so for a consultation or the likes. Ensuring the confidentiality of the patient’s inquiries is a sign of professionalism and is a must in all cases.
This one is simple; if your patient doesn’t feel comfortable, they won’t tell you everything that is bothering them. The doctor-patient relationship directly influences the effectiveness of the medical interview. If the patient does not feel that the doctor is very trustworthy, they will withhold important information from them. Also, if the patient is not comfortable in the environment and around the doctor, they won’t understand the questions being asked and will pretend to have understood everything said to them.
Take a non-judgmental stance allowing your patient to talk freely. For example, asking questions that start with “why?” would make the patient feel that they are being judged and questioned about the truthfulness of their feelings. This would have a negative effect on your doctor-patient relationship and would be detrimental in treating your patient.
Always be nice and show empathy. When an individual; regardless of their profession, shows empathy, people tend to gravitate towards them and trust their expertise. Your patient will divulge in all the bits and pieces of their worries and you will enjoy helping them on a deeper level.
Now, the most important tip of all is to LISTEN!! Make sure you use active listening and go back and check on the points the patient is making from time to time. Use phrases such as “ so you’ve been having these symptoms for two months now, is that right?”. This makes the patient feel like you care and are listening to what they are saying. Not only does this make your interview much more effective in gathering information but it also makes the patient feel like you are fully engrossed in their story.
This step is essential in any interview. This is a multistep approach. You must first understand their views and then show them that you’ve acknowledged them. After that, you must try to include them in your explanations and consequent actions.
This can be summarised in the mnemonic ICE. Where you ask about the patient’s “Ideas, Concerns, and Expectations”. Here’s how you might ask about each:
This helps you build your relationship with your patients and optimize the benefits you can get out of your interview. It makes them feel like their thoughts are important and being heard. Making the interview more of a two-sided conversation and less one-sided.
Simplicity is key. Although we all understand each other in the medical field, patients can have a hard time understanding us. Try to be as clear as possible, using the simplest terms without compromising meaning. You want your patient to understand you perfectly and the condition clearly. Therefore, try to avoid using medical jargon.
Always ensure using audience-appropriate language. You wouldn’t be talking to a child the same way you talk to an adult. Some patients might find it harder to understand you than others, so always alter your language depending on the audience.
I like to start my interview by mentioning everything we’ll be talking about in this session. Just make sure the patient knows exactly what is going on at all times so they can keep up and form questions accordingly.
This also includes going in a chronological order that makes sense to the patient and yourself. What I’m saying here is don’t start your interview explaining treatment measures without thoroughly explaining the actual condition to the patient and allowing time for any questions they might have on the issue at hand.
Providing good structure to your interview makes it easier for you to flow through the multiple phases without forgetting anything.
Aaaah, the dreaded “what do I need to ask next?!?!”. Don’t you worry, you’ve come to the right place *wink wink*. Any symptom needs to be analyzed in multiple aspects, the mnemonic OPQRST-AAA which is the alphabetical order from O to T, and then a triple-A reminds you of exactly what to ask. Let me show you :
O – Onset: when did the symptoms start? Is it acute or chronic?
P – Point: Where is the exact point of the pain? Is it substernal pain or is it on the sole of the right foot?
Q – Quality: Is the pain stabbing? Crushing?
R – Radiation: does the pain radiate to any area other than that point?
S – Severity: how severe is the pain on a scale of 1 to 10.
T – Time: is it worse during day or night? When you wake up from sleep?
A – Associating symptoms: is the abdominal pain associated with any nausea? Vomiting? Bowel movement changes?
A – Alleviating factors: is the pain made better by anything?
A – Aggravating factors: is the pain made worse by anything?
Use this mnemonic to ensure you got all the information you need about a certain symptom and then continue with your interview. Resting assured you did not forget anything in the history of presenting illness.
Studying the disease process and understanding the pathophysiology gives you an idea about what to ask for next. Let’s take for example a patient with heart failure. You would be asking them about chest problems and cough and so on, but if you take into account the pathophysiology of HF you would be thinking about how HF causes fluid overload. Then fluid overload would present as orthopnea and leg swelling etc. This would change your path of questions, you would remember important symptoms in the disease process and guide your interview accordingly.
The sense of what is important and what you should ask will grow as you learn new information about various disease processes. The more you study, the easier these interviews become! However, you are already well on the way to conducting a perfect interview so don’t worry about it.
A medical interview usually follows the same couple key areas of questioning. These areas are covered below.
You want to start with open-ended questions. These are questions that don’t have a yes or no answer. They allow the patient to talk freely and provide you with more in-depth answers. For example instead of asking “Are you feeling better today?”, you should ask “How are you feeling today?”.
You can then move on to closed-ended questions that require a more precise answer; including a yes or no. These included questions about specific symptoms like “do you experience dizziness with that?”. Keep in mind that closed-ended questions provide a limited range of responses and would greatly minimize the gains you can obtain from using open-ended questions.
Try to avoid leading questions as much as possible. These questions will lead the patient to give you an answer they think you want to hear. An example of this is you asking “ you do exercise regularly, don’t you?”. This implies that the patient should be exercising and so they would answer “Yes, of course” when in reality they aren’t doing much exercise.
Always ensure your patient understood all the points mentioned during the interview. Give them a quick summary of the main points mentioned, ensuring they understood everything and don’t have any more questions regarding any point.
Ensure the patient is comfortable with all the points mentioned and agrees to any steps to be taken afterward. Ask the patient if they have any corrections in the history, any questions, and if they would like to discuss anything further.
Brushing up on these points reminds the patient of everything discussed and reminds you; the physician, of any points you might have forgotten along the way.
Once you’ve guaranteed you are satisfied with the knowledge you’ve gained and the patient understands everything fully, thank your patient for their time and let them know they’re in safe hands. After all, you’ve done a great job! Keep it up!
The medical interview is a very easy practice but the gains we get out of it are innumerable. It might be a bit daunting at first; but trust me, there’s nothing to worry about. Watch some videos online or shadow a senior for a bit. But always remember to do as many interviews as you possibly can to sharpen your skills. As our wise elders always say, practice makes perfect (unfortunately, we can’t skip the practice part and skip right to perfect!). And remember, you are a step closer to where you want to be!!