The Patient Interview
After reading this chapter, you will be able to:
• Describe the major items found on a patient history form.
• Explain the primary tasks performed during the patient interview.
• Describe the internal factors the practitioner brings to the interview.
• Discuss the external factors that provide a good physical setting for the interview.
• Differentiate between open-ended questions and closed or direct questions.
• Describe the following nine types of verbal responses:
• Describe why the following are nonproductive verbal messages:
• Providing assurance or reassurance
• Asking leading or biased questions
• Interrupting and anticipating
• List positive and negative nonverbal messages of the interview, including:
• Describe how to close the interview.
• Define key terms and complete self-asessment questions at the end of the chapter and on Evolve.
Patient History
• Biographic data (age, gender, occupation)
• The patient’s chief complaint or reason for seeking care, including the onset, duration, and characteristics of the signs and symptoms
• Present health or history of present illness
• Past health, including childhood illnesses, accidents or injuries, serious or chronic illnesses, hospitalizations, operations, obstetric history, immunizations, last examination date, allergies, current medications, and history of smoking or other habits
• The patient’s family history
• Review of each body system, including skin, head, eyes, ears and nose, mouth and throat, respiratory system, cardiovascular system, gastrointestinal system, urinary system, genital system, and endocrine system
• Functional assessment (activities of daily living), including activity and exercise, work performance, sleep and rest, nutrition, interpersonal relationships, and coping and stress management strategies
Patient Interview
1. Gathers complete and accurate data about the patient’s impressions about his or her health, including a description and chronology of any symptoms
2. Establishes rapport and trust so the patient feels accepted and comfortable in sharing all relevant information
3. Develops and shows an understanding about the patient’s health state, which in turn enhances the patient’s participation in identifying problems
4. Builds rapport to secure a continuing working relationship, which facilitates future assessments, evaluations, and treatment plans
Techniques of Communication
Closed or Direct Questions
A closed or direct question asks the patient for specific information. This type of question elicits a short one- or two-word answer, a yes or no, or a forced choice. The closed question is commonly used after the patient’s narrative to fill in any details the patient may have left out. Closed questions also are used to obtain specific facts, such as “Have you ever had this chest pain before?” Closed or direct questions speed up the interview. The use of only open-ended questions is unwieldy and takes an unrealistic amount of time, causing undue stress in the patient. Box 1-1 compares closed and open-ended questions.