General Interview Perspective Be Careful

Be cautious when accepting the flattery of patients who are critical of the care they received from other physicians; these patients may have a long history of failed patient-physician relationships caused by unreasonable expectations.

Avoid being "inserted" into the middle of a family conflict by well-meaning family members. It is generally not helpful to agree to keep a secret ("Don't tell them I told you this, but..."). It is better to agree to discuss the subject and to insist on honesty with the patient ("Your daughter has shared with me that she is concerned about your drinking [or ability to live alone or angry outbursts]"). Playing along with the secret is usually unfair to patients and not in their best interest. Instead, it is often a perpetuation of the family's enabling behavior that has led to the perpetuation of the patient's problem, and at the least, it makes further communication with the patient and the formulation of plans difficult and uncomfortable.

Even though it may be tempting to appear an expert to the patient, a wise general policy is to avoid criticism of other health providers, whether verbally to the patient or in the medical record. When commenting on contentious issues and complex situations, appraisal from multiple perspectives is critical for understanding, and information should always be complete and in context. However, this broader perspective is almost never available at the patient interview.

Criticism of office staff behavior in the presence of the patient is inappropriate and may be damaging to the patient-physician relationship. Share constructive criticism only with staff members and only in private.

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