The Health Interview and Communication

Overview of the Health Interview

• The health interview represents a structured interaction between the healthcare professional and the patient.
• The terms and parameters governing this interaction should be stated clearly at the onset of the interview to facilitate a climate of openness and trust.
• The mutual goal of the interview process is the achievement of the patient’s optimal health.

The Process of Communication

• Communication is defined as the exchange of information so that each participant clearly understands the other.
• Communication is based on behavior, which includes both conscious and unconscious acts.
• A foundational premise is that all behavior carries meaning.
• The specific process of communication involves both the sending and the receiving of information.
• Both individuals involved in the exchange engage in verbal and nonverbal communication, both of which significantly influence the overall communication process.

Internal Factors Influencing Communication

Internal factors are those specific qualities and characteristics of the examiner that promote effective communication. There are $4$ primary internal factors:

• Liking Others: Maintaining a positive disposition toward people.
• Expressing Empathy: The ability to understand and share the feelings of another from their perspective.
• The Ability to Listen: Active engagement in hearing and processing the patient's information.
• Self-Awareness: Understanding one’s own biases, feelings, and reactions during the interaction.

External Factors and the Physical Setting

External factors relate primarily to the physical environment where the interview takes place. To foster good communication, the following factors should be optimized:

• Ensuring Privacy: Creating a space where the patient feels secure to share personal information.
• Preventing Interruptions: Minimizing distractions to maintain focus on the patient.
• Creating a Conducive Environment: Organizing the physical space to be comfortable and professional.
• Arranging Equal Status Seating: Positioning seats so that neither the examiner nor the patient appears dominant.
• Wearing Appropriate Attire: Maintaining a professional appearance to instill confidence.
• Documentation Management: Recording responses via note-taking or an electronic health record (EHR) must be done without interfering with the flow of the conversation.

The Three Phases of the Interview

The health interview is structured into $3$ distinct phases:

• Phase $1$: The Introduction: The examiner begins the interview by introducing themselves and clearly defining their professional role.
• Phase $2$: The Working Phase: This is the data-gathering stage.     * Open-ended Questions: Used initially to ask for narrative information, allowing the patient to express themselves freely.     * Closed or Direct Questions: Used subsequently to obtain specific information. These typically elicit short, $1$ or $2$ word answers.
• Phase $3$: The Closing: This phase signals that the interview is reaching its end.     * It provides the patient with a final opportunity to share concerns or express additional thoughts.     * The examiner should provide a brief summary of the information learned during the session.

Verbal Responses in Narrative Assistance

Different types of verbal responses are used to assist the narrative and facilitate data gathering. These are categorized by the "frame of reference" they utilize.

Responses Focusing on the Patient’s Frame of Reference: In these responses, the examiner reacts to the facts or feelings the patient has communicated:

• Facilitation.
• Silence.
• Reflection.
• Empathy.
• Clarification.

Responses Focusing on the Examiner’s Frame of Reference: In these responses, the examiner expresses their own thoughts and feelings regarding what has been shared:

• Confrontation.
• Interpretation.
• Explanation.
• Summary.

The Ten Traps of Interviewing

To enhance communication, examiners must avoid these $10$ nonproductive verbal message types:

• Providing false assurance or reassurance: Giving unfounded hope.
• Giving unwanted advice: Imposing personal opinions on the patient.
• Using authority: Positioning oneself as superior to the patient.
• Using avoidance language: Using euphemisms to avoid reality.
• Engaging in distancing: Using impersonal speech to create space between the examiner and the patient.
• Using professional jargon: Using technical language the patient may not understand.
• Using leading or biased questions: Framing questions in a way that suggests a "correct" or preferred answer.
• Talking too much: Dominating the conversation rather than listening.
• Interrupting: Cutting the patient off while they are speaking.
• Using "why" questions: These can come across as accusatory or judgmental.

Nonverbal Modes of Communication

Nonverbal communication is critical for establishing rapport, conveying information, and providing clues to a patient's underlying feelings. Key modes include:

• Physical appearance.
• Posture.
• Gestures.
• Facial expression.
• Eye contact.
• Voice.
• Touch.

Communication in Special Situations

Communication techniques must be modified based on the specific needs and developmental stages of the patient:

• Developmental Stages: Adjustments should be made for parents, infants, young children, adolescents, and older adults.
• Special Needs: Specific strategies are required for patients with:     * Hearing impairment.     * Acute illness.     * Intoxication or substance abuse.     * Specific emotional or behavioral states: patients who are sexually aggressive, angry, anxious, violent, or in tears.

Intercultural Communication and Language Barriers

• Cultural Sensitivity: Approach should be modified for patients from different cultures, as behaviors viewed positively in one culture may have negative connotations in another.
• Limited English Proficiency (LEP) and Hearing Impairment:     * Use a sign language interpreter, a bilingual team member, or a trained medical interpreter whenever possible.     * Warning: Avoid using a family member or close friend as an interpreter. This violates patient confidentiality, and the family member may intentionally or unintentionally edit or change the message.

Health Literacy

• Definition: Health literacy encompasses more than just basic reading; it includes the ability to utilize numeric information and the capacity to understand and remember verbal instructions.
• Verification Methods: To ensure the client understands provided information, examiners should utilize:     * Oral teaching.     * Written materials.     * The teach-back method, where the patient explains the information back to the examiner in their own words.