Jarvis: Physical Examination & Health Assessment, 6th Edition

Chapter 3: The Intervie !ey Points " Print This section disc#sses $ey points a%o#t the comm#nication process and techni&#es' A health intervie is a structured interaction between you and the patient. The r#les governing this interaction should be clearly o#tlined and a(reed on by you and the patient at the start of the interview. Your mutual (oal is the patient)s optimal health. Comm#nication carries you and the patient through the interview. Communication is the exchan(e o* in*ormation so that each person clearly understands the other. A two-person interaction usually has two roles: sender and receiver. When exchanging information both individuals engage in ver%al and nonver%al comm#nication. !nternal and external factors can affect communication. o Internal *actors are what yo# bring to the interview. Three internal factors promote good communication: li$in( others, expressin( empathy, and havin( the a%ility to listen. External *actors relate mainly to the physical settin(. You can foster good communication with certain external factors such as by ens#rin( privacy, preventin( interr#ptions, creatin( a cond#cive environment, and doc#mentin( responses without interfering with the conversation. "uring the first phase introd#ce the intervie . "uring the wor#ing phase (ather data. $tart with open+ended &#estions, which as# for narrative information. Then use closed &#estions which as# for specific information in short one- or two-word answers. "uring the closing si(nal that the intervie is endin( which gives the patient one last chance to share concerns or express himself or herself. Also briefly s#mmari,e hat yo# learned during the interview.

The interview has three phases: an introd#ction, a or$in( phase, and a closin(' o o

You can use different types o* ver%al responses to assist the narrative and help gather data. %ach response plays a role in the interview process but practice is needed to use them effectively and move among them smoothly. o Through *acilitation, silence, re*lection, empathy, and clari*ication you react to the facts or feelings the patient has communicated. Your response *oc#ses on the patient)s *rame o* re*erence. Through con*rontation, interpretation, explanation, and s#mmary your response *oc#ses on yo#r o n *rame o* re*erence thoughts and feelings.

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To further enhance communication avoid the ten traps o* intervie in(' These nonproductive verbal messages include: o o o o o o o o o o o o o o o o o /roviding *alse ass#rance or reass#rance, 2iving #n anted advice, 3sing a#thority, 3sing avoidance lan(#a(e, %ngaging in distancin(, 3sing professional -ar(on, 3sing leadin( or %iased &#estions, Tal$in( too m#ch, Interr#ptin(, And using . hy/ &#estions' Physical appearance, Post#re, 0est#res, 1acial expression, Eye contact, 2oice, And to#ch'

/ay attention to nonver%al modes o* comm#nication which include:

3onver%al comm#nications convey messa(es from the sender to the receiver. Wor# to develop the ability to read patients4 nonverbal behaviors and to monitor your own nonverbal communication. This section presents critical points a%o#t comm#nication in special sit#ations' 5odify communication techni6ues based on each patient)s developmental sta(e, including parents infants young children adolescents and older adults. 7earn to communicate effectively with patients ho have special needs such as those with a hearing impairment acute illness or intoxication and those who are sexually aggressive angry anxious violent or in tears. When a patient comes *rom a di**erent c#lt#re modify your approach as needed. 8ehaviors that one culture views positively may have different possibly negative connotations in another culture. 9or a patient with limited En(lish pro*iciency, use a %ilin(#al team mem%er or a trained medical interpreter whenever possible. Avoid using a family member or close friend as an interpreter because this violates the patient4s confidentiality.
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