Posts Tagged ‘interviewing’

Opening a Patient Interview: Part I, What to Say BEFORE Your First Medical Question

March 5, 2013

by Edward Leigh, MA

NurseDoor

The first few moments of the patient interview sets the tone for the patient experience — what happens in the first 10-20 seconds makes or breaks the experience.

Sequence of events for seeing a NEW patient: (in chronological order)

(Before you walk in the room, take a deep breath to recharge yourself! One more item, if you just had an onion-filled sandwich, please pop a mint in your mouth!)

Say patient’s name (e.g., “Hello, Mrs. Smith”). If you are unsure of pronunciation — ask FIRST before attempting to state name.  You may also want to check with colleagues about pronunciation before entering the patient’s room.

State your name & role (e.g., “Hello, I am Mary Smith. I will be your nurse.”).  Recent research has shown that patients prefer hearing both the first AND last names of the professional.

Meet the guests.  If possible, ask patient to introduce you so you can learn relationships (e.g., “This is my daughter, Carol.”). Repeat name after meeting (e.g., “Hello Carol, a pleasure to meet you.”). Remind them to feel free to add information and ask questions. It is vital to establish a great relationship with the patent’s guests.

Provide your photo / business card, if applicable. It is important to provide the card at the beginning, otherwise part way through the interview, the patient may state, “So who are you?”  I have seen this happen many times.

Signpost.  This word means to tell people what’s coming next in the interview (i.e., providing direction). Explain to them what will be happening relieves their anxiety. For example, you can say, “Today, we’ll first talk about what brought you in, then I will examine you and discuss treatment options.”

What about the handshake?  There are many opinions on this subject, often divergent. Should you shake the patient’s outstretched hand? Should you initiate the handshaking gesture? Gregory Makoul and his colleagues at Northwestern University’s School of Medicine in Chicago wrote an article in the Archives of Internal Medicine on this subject. Of the patients surveyed, 78.1 per cent wanted physicians to shake their hands. This study seemed to indicate the handshaking is desired among physicians, however it is unclear if this behavior is desired among other healthcare professionals.  I look at this topic on a case by case basis. For example, a handshake would be more of an expected gesture for a middle-aged man as opposed to a teenaged girl. Overall, from a patient experience perspective, I would suggest shaking hands. A physician recently asked me, “I always gel up before seeing each patient. If I see a patient who I suspect has the flu, if they initiate a handshake, what should I do?”  I suggested they shake the patient’s hand and then quickly gel up again. Not shaking an outstretched patient’s hand will severely damage the relationship.

Look for Part II soon … “Your Powerful First Few Questions.”

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book is Engaging Your Patients is due out in the Spring of 2013. http://www.CommunicatingWithPatients.com or 1-800-677-3256

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My Mother’s Recent Hospitalization Experiences: The Good, the Bad and the Ugly!

November 18, 2009

About a month ago, my mother was crossing the street with her friend. Just as she stepped on the sidewalk she started feeling faint and began to feel sick.  An ambulance was immediately contacted and my mother was taken to the ER.  My mother’s friend accompanied her to the hospital — she called us from the hospital and told us to come right over.

My brother and I entered the hospital’s ER to find my Mom awake and alert. An ER nurse told us that my mother’s EKG was abnormal and that she had a condition known as Atrial Fibrillation and would need to take the medication, Coumadin.

A few hours later, my mother was admitted to the hospital.  The physician on the unit determined the underlying medical issue, dehydration.  We thought my mother was drinking enough fluids — obviously not.  My mother was in the hospital for four days.  Upon proper hydration, she was feeling fine and looking forward to returning home.

These are my observations regarding my mother’s recent hospitalization.  I base the observations on my PIE Model of Patient Communication.
P  Psychosocial (providing emotional support)
I  Interviewing (getting information)
E  Educating (giving information)

Psychosocial Dimension

Everyone was very friendly and kind.  I found the healthcare professionals to be very caring and treated my mother quite well.  However, what I did not find was any direct empathic responses.  I was waiting for someone to make a statement such as, “I know this must be difficult for you.”  Every medical center and practice always mention that empathy is an important component of their work.  In reality, empathy is rarely displayed.  This is due to the fact that healthcare professionals are not educated on how to convey empathy.

Interviewing Dimension

The questioning techniques employed were sufficient to gather information from my mother and I.  There was the usual issue of asking too many closed questions in succession and not allowing the patient sufficient time to discuss their medical issues.

The biggest issue was closing the interview with this question, “Do you have any questions?”  That is a closed question.  To encourage patients to ask questions, we should rephrase the question as an open question, “What questions do you have?”

Educational Dimension

Brace yourself and fasten your seat belt!  This was by far the weakest area.  Upon discharge, the unit nurse reviewed the discharge instructions, which were disjointed at best.  There were so many issues, I almost did not know where to begin my evaluation.  These are the problem areas and suggestions for improvement:

Excessive use of medical jargon:  The discharge instructions used the terms presyncope and mixed hyperlipidemia.  I am in the healthcare field and know what the terms mean, but what if I wasn’t in the field and didn’t know what the words meant?  Use patient-friendly language.

Ultimate diagnosis not mentioned. My mother initially fainted, but was ultimately diagnosed with dehydration by the attending physician.  Dehydration was never mentioned in the discharge report. This is a perfect of example of how poor handoffs lead to medical errors. At the time of discharge, I asked about the dehydration and how much fluid my mother should consume.  The nurse said, “About 3-4 glasses a day, I guess.” (Having a solid healthcare background, I researched the topic and developed a daily fluid intake plan for my mother.)
Vague comments. The discharge form states, “Will order Influenza vaccine.” Was it ever administered to my mother?  I called the hospital and was first sent to the Medical Records Department — they had no idea.  The Medical Records Department sent me to the unit, who also had no idea.  The unit nurse did say this, “Your Mom most likely did get the flu shot.  We usually give it to people 50 or over.”  Why didn’t the report state, “Patient was given a flu shot?”

No educational materials / resources.  In spite of the fact my mother was diagnosed with dehydration, no information was provided.  A brochure, website or organization to contact would have been helpful.

Overall, the healthcare professionals who took care of my mother were kind and skilled at their jobs.  There were some issues with the interviewing questions and empathic responding, however the biggest concern was the poor patient education component.  If patients do not comprehend their medical situation, they are at risk.

I signed the form for my mother (I have Power of Attorney).  By signing the form, I indicated I understand the discharge papers.  I actually did understand them — I have been in healthcare over 20 years.  My biggest concern is that most people will sign the form stating they understand, but they really do not.

Hospitals need to do a better job at educating patients.

********************************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com / 1-800-677-3256

Great Communication Skills = Lower Risk of Malpractice

April 1, 2009

medicalmalpractice

A friend who worked as an oncology social worker for many years told me of
a pediatric oncologist who was working with young cancer patient.  The
oncologist
accidentally gave her a very large (and potentially fatal) dose of
chemotherapy.  The young girl survived this medical error.  My
first thought — that girl’s parents will immediately go to an attorney.
However, that was not the case.

The oncologist spoke to the girl’s parents and explained what happened.
She said she felt terrible and said, “I’m sorry.”  She also said, “Based on
what happened I think it would be best if your daughter worked with
another oncologist.”  The
parents said, “We don’t want another oncologist.  You have been so
wonderful to our daughter.  You were there holding her hand when she was
ill from the various treatments.  We want you to continue treating our
daughter — we won’t have it any other way!”  By the way, they also told
the oncologist they had no plans to take legal action.

Why did the parents have no intention of pursuing litigation?  One simple
reason
— they liked the oncologist.  In general, people don’t sue people they
like.  We get people to like us through great communication skills.

The June 4, 1997 issue of the Journal of the American Medical
Association (JAMA)
included an enlightening article called,
“Physician-patient communication. The relationship with malpractice claims
among primary care physicians and surgeons.”  The primary objective was to
identify specific communication behaviors associated with malpractice
history in primary care physicians and surgeons. The research compared
the communication behaviors of “claims” vs. “no-claims” physicians
using audiotapes of 10 routine office visits per physician. The study
consisted of 59 primary care physicians (general internists and family
practitioners) and 65 general and orthopedic surgeons and their patients.
The physicians were classified into no-claims or claims. There was
significant differences in communication behaviors of no-claims and claims
physicians in the primary care physicians group (no differences in
surgeon group). The helpful behaviors exhibited by the no-claims primary
care physicians included:

Length of primary care office visit
The study demonstrates a strong
correlation between extra time spent with patients and lower frequency of
malpractice claims. Since patients dislike feeling rushed or ignored,
physicians who are “too busy” to sit down, listen attentively, and respond
to a patient’s questions may set the stage for problems down the road.

Engaging in a dialogue
Physicians should encourage two-way communication that includes:

using orientation statements, which educates patients about what to expect and the flow of a visit.  This includes statements such as, “First, we’ll talk about your stomach pain, then I will examine you, and then we will
talk about ways to treat the problem.”

applying facilitation techniques to obtain patients’ opinions, check for understanding and encourage patients to talk.   These include questions such as, “What do you think is causing the pain?”

using applications of humor, laughter and encouraging statements, such as “I’m happy to hear you are feeling better.” Use of humor and laughter express warmth, friendliness and empathy and builds a bond between physician and patient.

inquiring into psychosocial and lifestyle issues, such as, “You said you went on an anniversary cruise last month, how was it?”

providing information and advice, such as by making a statement like this, “The medication may make you feel sleepy.”   This also includes providing educational literature and suggesting organizations to contact. Imparting information
and advice in a manner that demonstrates the
physician’s genuine caring tends to diffuse patient anger and resentment.

Physicians who have been sued for malpractice often cite “unrealistic
expectations”
on the part of their patients. Encouraging two-way communication helps the
patient develop appropriate expectations about a medical visit, and
prompts the sharing of critical information.

Breakdowns in communication between physician and patient fuel distrust
and pent-up anger. No one wants to feel that their concerns are ignored,
nor that their problems have been minimized or disregarded. Factor in a bad
outcome to the scenario and we are setting the stage for a lawsuit. On the
other hand, effective communication skills tends to enhance patient
satisfaction.

The study identifies specific and teachable communication behaviors
associated with fewer malpractice claims for primary care physicians.
Physicians can use these findings to improve communication
and decrease malpractice risk.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  He is the author of the book, Communicating with Patients (due out in the summer of 2009). For more information about his high-impact communication skills programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Patient Interview not Going Well? Start Again!

February 23, 2009

doctorexplaining

Your interviewing a patient and things are not going well.  The patient
does not seem to be following or even worse seems upset.  Dr. Lony C.
Castro, a professor and chairwoman of the Obstetrics and Gynecology
Department at Western University of Health Sciences, suggests starting the
interview again.

Dr. Castro wrote an article for the Los Angeles Times in which she talked
about the benefits of a “second take” (Dr. Castro is in LA so she can use
movie jargon!).  She discussed an experience she had with an
end-of-the-day patient at a time when she was hoping to wrap up on time
and get home.  Her patient meeting did not go well and she thought, “If
only I
could start over.”  Then she decided to do just that — she asked the
patient if we could start again.  She began the interview again and it was
very successful.

Tips to make the first encounter the best:

Stop for a moment and mentally prepare.  Before you knock at your next
patient’s door, take a deep breath and mentally prepare for the visit.
If you are distracted with other patient issues or your own personal
issues, it is time to put those aside and focus on this particular patient.

Explain medical information to patients in an understandable way.
Rushing through complicated medical details can confuse patients.  They
will end up feeling frustrated.  If you don’t think you have time to
explain, think about how much time will be spent if the patient doesn’t
understand and has to call you back or make a return visit.

Body language and nonverbals.  Make sure yours are patient friendly —
good eye contact, facing the patient and never keeping your hand on a
doorknob!  Also, look at the patient’s cues — do they seem puzzled,
anxious or distracted?

If you need to start over:

After obtaining the patient’s permission, Dr. Castro physically left the
examination room and began the interview from the very start.  This second
try worked and the patient was very satisfied with the meeting.

You do not necessarily need to leave the room.  You can simply state, for
example, “I know this is a lot of information.  Let’s start again, if that
is acceptable to you.”

Work on making the first encounter the best possible meeting.  However, if
you need to start again, that is fine too.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content communication skills programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Effectively opening a patient interview: create comfort from the start

February 9, 2009

patientshakinghands

The first few seconds of meeting a patient are critical to establishing rapport, helping the patient feel at ease and setting the tone of the interview. 

Wash your hands both before AND after seeing each patient.  Many healthcare professionals prefer to wash their hands in front of the patient so the patient does not have to worry that they will pick up the previous patient’s germs.

 

These are guidelines to beginning an interview with patient:

Take a Deep Breath. During a busy day, you will develop a fast pace and your patients may pick up on that in your actions and voice.  Taking a quick deep breath will relax you and prepare you for your next patient.

 

Knock at the Door. After a tap on the door announcing your presence, wait for the patient’s response.  Do not just immediately open the door.  Most clinicians knock and immediately walk in, however it is best to knock and wait until you hear a response and then enter.  This only takes a few seconds.

 

Patient’s Name

* When first entering the room, use the patient’s name.  This will immediately give your interaction a personal touch.  From the start, people will feel more at ease and open to discussion. (Use the patient’s name first, then yours.  We want the patient to feel special and using their name first will create this environment.  Using your name first creates an authoritative feel to the interaction.  If you are meeting a patient for the first time, state your role. For example, “Hello Mrs. Smith.  I am your nurse, Barbara Jones.”)

* Begin with a more formal approach with new or older patients.  For example, walk in and say, “Hello Mr. Smith …”  Address them this way, unless they request otherwise.

* If you are seeing the patient for the first time and are unsure of the pronunciation, ask!  To avoid the patient awkwardly telling you, “My last name is actually pronounced …”  On the patients’s chart, it would be a good idea to phonetically write their name.  For example, my last name is “Leigh.” People often mispronounce it as “Lay.”  In my chart, it can be noted, “Last name pronounced ‘Lee.’”  This is not only for your reference, but anyone else who reviews the chart.

* Be sure names are updated, as in the case of marriages / divorces or step children.  To avoid any awkward moments — asking about “life changes.” You may want to say, “We are updating our records, have their been any name changes?”

.

Shake hands, if you feel this is appropriate for the patient. According to a recent article in the Archives of Internal Medicine, most patients want physicians to shake their hands when they first meet.  The article dealt with physicians, however the shaking hands gesture would most likely apply to other healthcare professionals.

 

Acknowledge others in the room, such as a family member or friend.  Be sure to get their names. Shake their hands if appropriate.  This acknowledgment is very important since you want to create a positive image with these family members as they will play key roles in the patient’s compliance.

 

Start with an open ended question.  This includes the question, “What brings you here today?”  Let the patient talk for at least a minute before asking questions.

 

By following these suggestions, patients will feel comfortable and ready share medical information.  An effective start translates into an effective interview!

 

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content communication skills programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256