A patient just walked in and gave you that laundry list of issues. You might become frustrated and think, “Where do I start with all the information?”
I’ve been having diarrhea for the past few days. I’m always in the bathroom. All the bathroom trips are so difficult because something is wrong with my one knee. I also feel queasy. While this is going on my heart is racing, maybe because of my nerves. I also have a lingering cough. Did I mention my jaw hurts?
This article will provide top strategies to help you gather and organize information in a timely fashion while still maintaining rapport and efficiency.
Rapport Before Report
Outside of emergency situations, first briefly focus on the emotional aspects of a patient’s experience and then move to the medical part. This action will assist you as prepare to gather patient information. This process puts the patient at ease, and they are more likely to be friendly and forthcoming with all information.
If the patient you are speaking with mentions their abdominal pain is making it hard for them to focus on their responsibilities in the workplace, it would seem logical to immediately ask about their symptoms. Stop. This person is having medical issues, but they are also describing strong emotions.
Instead of immediately asking about the symptoms, first use empathy. For example, you can say, “That must be very challenging.” The patient now knows you care about them and what to help. Now you are ready to ask about the medical issues. Unfortunately, many healthcare professionals bypass the emotional issues and go right to the medical situation. This leads the patient to think, “This person doesn’t care about me.”
The reason empathy works is because it leads to trust. Patients who feel trust in their healthcare team are more likely to be compliant—and hence have better outcomes. Let’s say two of your colleagues gave you advice: One colleague you trust, and the other you are not too sure about. Whose advice are you more likely to follow? Of course, the person you trust.
If a patient is asymptomatic, there are still ways to connect emotionally to enhance the interviewing process. In your electronic medical records, note the hobbies and interests of patients. In this way, when they walk in the door you can ask about their garden or favorite sports team. You put them in a good mood and that makes for a much more pleasant interview. My wife and I live with a houseful of pug dogs. When I walk into my dentist’s office, the first thing they say is, “How are the pugs?” I am immediately in a wonderful mood.
Opening Line
Asymptomatic patient: If the patient is not experiencing any issues, such as a person having a screening colonoscopy, then the opening line could be a simple, “Hello.” Outside of general updates regarding their health and medications, a friendly welcome works fine.
Symptomatic patient: First of all, do not say, “How are you?” to a symptomatic patient. This may seem odd and counterintuitive, but there is a reason to avoid this question. According to John Tongue, M.D., chair of the American Academy of Orthopedic Surgeons Communications Skills Project Team, “In the U.S., this is a greeting, not a question, that can put the ill or injured person in the awkward position of saying they are ‘fine,’ just before telling you their story or problem(s).”
Start with an open-ended statement or question, such as, “Tell me what is going on,” or “How can I help you today?” I used to ask patients, “What brought you here today?” but stopped after a patient responded by saying, “The bus.”
If you know a patient is coming in with a specific complaint, start with a general question anyway. This action is recommended in case the patient has a hidden agenda. The complaint they have on the phone may not be the real issue. After the patient states their chief complaint, do not yet ask for details until you ask these two words, “What else?” Asking these two important words will get all the issues out in open and avoid the dreaded, end-of-meeting, “Oh, by the way…” issues. You don’t want the patient to drop a bombshell just as you are about to walk out the door.
Nonverbal Factors
The patient: While asking the patient questions, look at their body language. Are you seeing any discrepancies? Does the patient say they do not feel stressed, but you notice their legs are trembling? Actions speak louder than words. Patients could say one thing, but the body movements tell the real story.
The professional: During the interview, look at the patient. Eye contact is a critical to tell the patient you are with them as they share their story. Based on the physical setup of the medical environment, sometimes eye contact may be challenging, such as when the patient is at a ninety-degree angle. However, on occasion, turn and look at the patient.
If possible, sit down so you are at the same level, eye to eye. Sitting sends the message, “I have time for you.” Patients perceive you are with them for longer periods of time when you sit. If you have one quick question for a patient, sitting is not necessary, but if the interview will be lengthier, have a seat.
Be Patient
Leana Wen, M.D., is the co-author of the book, “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” The book is for patients on how to have more effective interactions with healthcare professionals. However, her strategy to help patients is something every healthcare professional must understand. Wen tells patients, “You can’t just give symptoms; you have to give your story.”
When interviewing patients, focus on their story, not individual symptoms. A series of disjointed symptoms may be hard to piece together, but a story in chronological order can solve the mystery.
Healthcare professionals are often so focused on symptoms, they lose sight of the story, or “the big picture.” We must allow patients time to speak without being interrupted so they have sufficient time to tell their story. The type of questioning seen below could be problematic:
Patient: “My belly hurts.”
Professional: “Is the pain worse on the right or left?” Patient: “The right, and—”
Professionals: “Is the pain worse when you sit or stand?”
When we constantly interrupt patients, we may miss the story and may miss the real medical issue. In addition, it’s simply rude. Instead, ask an open question and let them tell their story with an occasional “Go on,” or “Tell me more,” sprinkled in the conversation. Once you have heard the entire story, then you are ready to ask the specific details.
I am a firm believer in this story process because I was misdiagnosed for over a decade due to no one giving me the time to share my story. About 20 years ago, I began having sinus headaches. I visited my family doctor’s office and was told to try over-the-counter medications. The meds didn’t help, so I returned to the office. I was then told I had an infection and was put on antibiotics. After taking a course of antibiotics, I had no symptom relief.
Next, my family doctor referred to an allergist, who discovered I had an allergy to molds. We thought we found the answer to my problem. I was put on allergy shots. After two years, my headaches got worse. I stopped the allergy shots and for years spoke to different healthcare professionals.
My family doctor then suggested trying the allergy route again with a new allergist. The new allergist’s style of interviewing was dramatically different than everyone else I spoke with during my struggle to get answers. She said, “Tell me about your headaches,” and she let me talk with no interruptions except for an occasional, “Go on.”
The other professionals I saw would constantly interrupt with questions about my specific symptoms. While she let me talk, I revealed that when the headaches got bad, I would feel nauseated and sometimes vomit. After I was done telling my story, she stated, “No allergy testing will be done today. You don’t have sinus headaches, you have migraines.” I was misdiagnosed for years because no one gave me the chance to tell my story, as they were too busy focusing on individual symptoms. I wasn’t closed off to discussing the GI symptoms; I simply was never allowed to talk long enough to reveal them.
The best way to get to the story is ask an open question, stop talking, and start listening.
Too Many Issues, Not Enough Time
The example used at the beginning of this article (in which a patient has a large list of issues to discuss) must be handled in a thoughtful manner. We want to maintain an excellent patient experience but also manage all the medical issues. There is right way and wrong way to handle this situation. Below are examples of a harsh inappropriate response and a sensitive helpful response.
Ineffective response: “We don’t have time to discuss all those issues.” This response results in the patient feeling angry. This response doesn’t set the stage for a productive interview since we started in a negative manner.
Effective Response: “I wish we had time to discuss everything today. How about if we discuss these two issues: ______ and ______. We’ll schedule another appointment for the other issues. How does that sound to you?” This response is friendly and creates a wonderful experience for the patient. This response also highlights shared decision-making, since you asked the patient their thoughts on your suggested course of action.
Avoid “Why” Questions
Using the word “why” can often be seen as judgmental and should be avoided. This will make the question seem much harsher for the patient, rather than putting them at ease.
Think about the questions you heard growing up (at least, I heard them as a kid): “Why is your room so messy?” and “Why didn’t you eat your vegetables?” These questions are toxic because they come across as accusatory, and since the healthcare environment is a therapeutic milieu, we should create a comfortable place for patients.
Converting “why” questions to “what” questions creates a friendly feel to the interview. Here are examples:
“Why” question: “Why did you stop wearing your support stockings?”
“What” question: “What was happening that led you to stop wearing your su
pport stockings?”
“Why” question: “Why did you stop taking your medication?”
“What” question: “What could we do to get this medication back in your life?”
“Why” questions should also be avoided when talking to colleagues, family members and friends. These types of questions make everyone feel defensive.
Use “I” Language, Not “You” Language
Using the word “you” is verbally pointing your finger at the patient. During the interview, if the patient states they were not compliant or engaged in unhealthy activities, do not use “you” language. The example below will clarify the vast benefits of “I” language in these situations.
An example of a diabetic patient who admits to not being compliant with their diet.
“You” statement: “You have to watch your diet.”
“I” statement: “I want to help you. I want you to feel better. Let’s talk about your diet.”
The “you” example sounded harsh, while the “I” example sounded caring.
To enhance your interviewing skills even more, combine “you” language with “non-why” questions, and you’ve got a winning strategy.
Family Dynamics
Focusing on the patient, ignoring the family: I have observed thousands of healthcare professionals interacting with patients. In many cases, I have seen the professional walk in and immediately start speaking to the patient—but completely disregard the family members or friends in the room. This is a problem for many reasons.
First of all, you want to be sure the family members also have a good experience. In addition, the family members can add to the story as you ask questions. Yes, direct your questions to the patient, but also be sure to let family members know they can add to the discussion. Family members are your allies.
When it comes to focusing on the family but ignoring the patient, just because a person is older doesn’t mean they can’t answer questions. I recall many times when I would take my mother to a medical appointment, the healthcare professional would look at me and say, “How is she doing?” My mother wasn’t having any cognitive issues and would feel very frustrated that the questions were being directed at me. If the patient is cognitively aware, ask them the questions.
Summarize the Patient’s Story
After the patient has shared their story, briefly review the story to be sure you have all the facts in chronological order. This is a very important process. In this way, you can verify you have not missed any important details.
Smoothly flowing interviews help keep patients satisfied and safe. They also help professionals, too. By following the tips in this article, you’ll be more productive and feel less stressed.
