Chapter 3 of this book discusses the interviewing process aimed at generating the patient’s story and how it differs from the format of the health history. The authors consider interviewing to be both a skill and an art that make it possible for healthcare professionals to relate effectively with the patient. More importantly, a patient-centered interview which is focused on understanding symptoms and disease from the patient perspective plays a significant role in improving health outcome, reducing errors, improving functional status, and reducing litigation. This differs from the health history format that focuses on the specific type of information that healthcare professionals wish to obtain.
This chapter identifies several fundamental techniques necessary for therapeutic interviewing to create an effective and healing relationship with the patient. These techniques are supposed to guide a healthcare professional in creating a deeper relationship with the patients and making them feel understood and cared for. The most important among these techniques include active listening and empathic responses. These two helps healthcare professionals to focus on what the patient is saying both verbally and nonverbally as well as show concern to the patient feelings. Other techniques include guided questioning, validation, nonverbal communication, empowering the patient, transitions, summarizations, reassurance, partnering, and summarization. Guided questions portray interest in the feeling and deepest disclosure of the patient, and hence it becomes possible to obtain the full story of the patient.
This chapter also discusses the sequence and framework of the interview. This pertains to the preparation of the interview, the sequence that should be followed in the interviewing process as well as the cultural context that should be put into consideration. Preparing for the interview requires planning, where a number of steps are followed. The first involves reviewing the clinical record of the patient so as to obtain background information about the patient. The second involves setting goals for the interview, followed by portraying professional clinical behavior and appearance and lastly adjusting the environment. The sequence of the interview outlines the procedures that the interview is expected to follow. Through this sequence, the healthcare to pay close focus n the feelings of the patient assists the patient to express them, respond to them as well as validate their significance. Healthcare professionals are supposed to maintain cultural humility when interviewing so that they can show a respectful attitude toward individuals of different cultures. This will make it easy to interact with the patient and make them feel understood.
Next, this chapter looks at how healthcare professionals can effectively interview a patient who turns out to be more challenging in the interviewing process. Examples of challenging patients include silent patients, confusing patients, patients with altered cognition, the talkative patient, and angry patients. Other factors that may make a patient challenging include language barriers, physical disability, low level of health literacy, limited intelligence, and discussing sensitive topics. When handling such patients, the authors recommend that health professionals be aware of how they react to avoid making the patient uncomfortable. More importantly, the success of healthcare professionals to get stories from challenging patient greatly depend on experience. When carrying out interviews, ethics and professionalism should guide every interaction that the healthcare professionals have with the patients. Ethical principles that can guide professionals include confidentiality, autonomy, beneficence as well as nonmaleficence. These principles help clinicians to attain the best interest of the patient.