What is a patient-centred interview?
A patient centred interview:
focuses on the patient’s needs in the interview
makes history-taking and problem-solving more accurate
promotes an active role for the patient in planning and carrying out treatment plans (Shared model)
enables more efficient practice
Why is it important to use patient centred interviews?
Patient centred interviews allow paitents to express their main concerns. This:
Improves diagnostic efficiency
Increases patient satisfaction
Increases concordance with management plans
Reduces the number of symptoms
Why is it important to seek the patients' specific requests
Specific requests may not be apparent from the presenting complaint
Patient satisfaction is improved if the patient is acknowledged
Patients look for a variety of information in primary care, a minority seek medication
Only a minory of patients voice all their agendas in the consultation
What are four components that a doctor should do in a patient centred interview?
Allow patients to express their major concerns
Seek the patient's specific requests
Facilitate the patient's expression of their feeling
Gives the patient information
Why is it important to provide patients with information in the consultation?
Doctors often over-estimate how much information is provided.
Patients that are coached in their understanding of chronic illness acheive improved physiological outcomes (diabetes, hypertension and peptic ulcer disease)
Why is it important to teach communication skills?
It is a core clinical skill
It is a series of learned skills
Experience can be a poor teacher of communication skills
Communication can be taught
Changes resulting from communication skills training can be measured
Changes resulting from communication skills training can be retained
What are the components of the Calgary Cambridge Model?
Commencing the consultation
Explanation and planning
Closing the consultation
Building the relationship
What are the categories of competence in the Leicester Assessment Package?
Behaviour/relationship with patients
What are the objectives for the start of the consultation?
Establishing a supportive environment and initial rapport
Developing an awareness of the patient’s emotional state
Identifying all the problems or issues that patient has come to discuss
Establishing a mutually agreed plan for the consultation with the patient
Developing a partnership with the patient
Name four things that should be done to prepare for the consultation
put aside the last task
attend to personal needs and comfort
shift focus to consultation at hand
conclude these activities before greeting the patient
State four things you can do to establish rapport with a patient
greet the patient, obtain patient’s name
introduce self, role, nature of interview
demonstrate interest and respect, attend to patient’s physical comfort
How can you identify the reasons for the consultation from the patient?
use open questions
listen attentively without interruption
facilitative the patient's responses
pick up verbal and non-verbal cues
confirm list and screen for further problems
negotiate agenda taking both patient’s and doctor’s needs into account
What are the objectives for gathering information from the patient
Exploring the patient's problem to discover the biomedical perspective, patient's perspective and background information.
Ensuring that information is accurate, complete and mutually understood
Ensuring patients feel listened to, and that their information and views are welcomed and valued
Continue to develop a supportive environment and collaborative relationship
Structuring the consultation to ensure information can be gathered efficiently, and enable the patient to be involved in the interview.
What skills are needed to explore the patient's problem in a consultation?
encourage patient to tell their story
use open and closed questioning techniques
facilitate patient’s responses
pick up verbal and non-verbal cues
clarify patient’s statements
summarise to verify own understanding
use concise, easily understood questions and comments
avoid or explain jargon
establish date and sequence of events
avoid multiple questions
avoid leading questions
What in addition to the clinical information, should be actively gathered in the consultation?
Need to actively determine and explore patient's ideas, concerns and expectations and encourage the patient to express their feelings.
What are the objectives for building a relationship in the consultation?
Developing rapport so the patient feels understood, valued and supported
Establishing trust between doctor and patient, laying down the foundation of a therapeutic relationship
Encouraging an environment that maximises the consultation process
Enabling supportive counselling as an end in itself
Developing and maintaining a continuing relationship over time
Involving the patient so that s/he understands and is comfortable with participating
Reducing potential conflict between doctor and patient
Increasing the patient’s and doctor’s satisfaction with the consultation
What are the skills required to build a good relationship with the patient in the consultation?
Non-verbal: use of notes, pick up patient's nonverbal cues, demonstrate appropriate nonverbal behaviour.
Developing rapport: accept patient's views and feelings as legitimate, use empathy, acknowledge patient's views and feelings, provide support, deal sensitively with embarrasing and disturbing topics.
Involving the patient: share thinking with the patient, explain rationale, during physical examination explain and ask permission
How can you provide structure to the consultation as a doctor?
Make the organisation clear: Signposting, summarise to confirm understanding
Pay attention to the flow of the consultation: structure the interview in a logical sequence, keep to time, keep the interview on task.
What are the objectives for closing the consultation?
Confirming the established plan of care
Clarifying the next steps for both doctor and patient
Establishing contingency plans
Maximising patient adherence and health outcomes
Making efficient use of time in the consultation
Continuing to encourage patient to feel part of a collaborative process and to build the doctor -patient relationship for the future
What skills are required to effectively close the consultation?
Forward planning: decide with the patient next steps are for patient and doctor, safety net (if anything should happen between now and then)
Ensuring appropriate point of closure: summarise, final check for any other questions.