The Interview

Jarvis Chapter 3

Subjective Data

What the patient says that is unable to be verified by observable/clinical findings and observations

Objective Data

What you obtain through physical examination

Contract

The interview is a contract between you and your patient

• Concerns the client needs and expects from healthcare

• What you, as a healthcare provider, have to offer

• The mutual goal is optimal health for the client

• Terms: time and place of meeting, succeeding physical examination, introduce yourself and your role, purpose of the interview, how long it will take, expectation of participation, presence of any other people and why, confidentiality, and any costs to the patient

Verbal Communication

The words you speak, vocalization, the tone of voice

Nonverbal Communication

• as important as verbal

• Body language: posture, gestures, facial expressions, eye contact, touch, foot tapping, chair placement

Internal Factors

The factors that are specific to you (the examiner). As communcication skills grow there are four inner factors

1. Liking others: generally optimistic view of other people, tolerance, warmth and caring, respect

2. Empathy: viewing the world from the other person’s inner frame of reference while remaining you, no criticism

3. Ability to Listen: active role in the process, attention is focused on the patient, ask follow up questions, understand what they are telling you

4. Self-Awareness: understand personal biases, prejudices, stereotypes, your behaviors and responses

External Factors

Preparing the location of the interview to be optimal

1. Ensure Privacy: close the door/curtain, make sure comfort is ensured, and other people in the room

2. Refusing Interruptions: concentrate on and establish rapport with the patient. If you know you might be interrupted, tell the patient, inform colleagues you do not wish to be interrupted unless there is an emergency

3. Physical Environment: temperature, good lighting, quiet, and remove distracting objects / equipment

4. Dress: Interviewer should dress appopriately and cleanly

Zones of Personal Space

1. Intimate (0-1.5 ft): best for assessing breath and body odors, vital signs

2. Personal (1.5-4 ft): most of the physical assessment

3. Social (4-12 ft): impersonal business transactions, most of the interview (sitting in a chair)

4. Public (12+ ft): interaction with others is impersonal, speaker must project voice, facial expressions are less visible

Equal-Status Seating

• Both you and the patient should be comfortably seated at eye level

• Allow them to face you or to look straight ahead

• Avoid standing

Working Phase

The data-gathering phase of your relationship with a patient

Open-Ended Questions

• Asks for narrative infomration

• States topic to be discussed but only in general terms

• Use it to begin the interview, to intro a new section of questions and whenever the person introduces a new topic

• Unbiased — patient can answer however they like — allow for full expression

Closed / Direct Questions

• Ask for specific information

• One - two word answer, yes or no, or a forced choice

• Limits the answers

• Help you elicit specific information and are useful to fill in any details that were initially left out after the person’s opening narrative

• Useful when you need specific medical facts

Verbal Responses

• Facilitation: general leads, minimal cues; encourages client to say more, shows interest; mhm, nodding yes, leaning forward

• Silence: communicates that the client has time to think, prevents interruptions in the thought process, observes the client and notes nonverbal cues; count to ten, wait for a response, do not fidget while being silent

• Reflection: echoes client’s words by repeating part of what they said, express feelings behind words, help elaborate

• Empathy: names a feeling and allows it to be expressed, accepts and strengthens rapport

• Clarification: useful when person’s word choice is ambiguous or confusing, summarize their words and ensure you understand

Ten Traps of Interviewing

1. providing false reassurance

2. giving unwanted advice

3. Using authority

4. using avoidance language

5. distancing

6. using professional jargon

7. using leading or biased questions

8. talking too much

9. interrupting

10. using “why” questions

Health Literacy

The ability of a patient to understand instructions, navigate the health care system, and communicate concerns with the health care provider

Interprofessional Communication

Communication that occurs between 2 or more individuals from different health professions

• SBAR method is effective