Interviewing Techniques

R. Hal Ritter, Jr., Michael D. Reis, and Terry G. Rascoe

Chapter contents

The Listening Environment

167

Technology

170

Maximizing the Time

168

Complementary and Alternative Medicine

170

The Interview Process

168

Religion and Spiritual Issues

170

Cultural Competency

171

Basic Communication

168

The Participating Patient

169

Assessing for Unhealthy Alcohol Use

172

Difficult Patient Situations

169

Interviewing Specific Groups

172

General Interview Perspective: Be Careful

172

Barriers to Effective Communication

169

Age Considerations for the Interview

172

Time Demands

169

Specific Concerns

174

Interruptions

170

Conclusion

175

• Listening is a key element for any successful interview.

• Building bridges of understanding helps to manage the various difficulties of the interview.

• Being sensitive to various forms of diversity, including disabilities, religious issues, and ethnicity, will enhance communication and participation by the patient.

The art of interviewing is a skill that is fully developed only through experience. Although various decision trees and protocols can be followed as the clinician seeks to confirm or rule out a preliminary hypothesis, the process of the interview often determines whether the therapeutic relationship is beneficial or deleterious to the outcome. Ritter and Wilson (2001) observed that listening is a key element in establishing the "three Rs" of interviewing: rapport, respect, and relationship. The quality of the relationship between the physician and patient is itself therapeutic, and the quality of this relationship will enhance or deter trust in the physician's care and the patient's adherence with the physician's recommendations.

Asay and Lambert (2009) discuss Michael Lambert's extensive, quantitative studies of contemporary psychotherapy, which validate that 30% of any therapeutic change is based on the quality of the relationship between the clinician and the client (LOE Grade A). This relationship is based on listening, mutual respect, empathy, and acceptance of the client.

Norfolk and associates (2007) note that the empathy necessary for rapport is based on trust and cooperation between physician and patient, and "rapport" is defined by the quality of the "doctor's understanding of the patient's perspective on his or her problem." Empathic skills "are internal diagnostic skills running parallel to those used to assess the patient's clinical presentation, and they allow the doctor to first identify significant clues to the patient's thoughts and feelings." These clues for understanding the patient's perspective may be verbal, nonverbal, or both (LOE Grade A).

In this regard, listening is a multisensory process. The physician listens to what is spoken, "listens" with the eyes for nonverbal behaviors, and "listens" with the fingers as examinations are completed. Rapport, respect, and relationship are enhanced by the physician taking the time to listen and understand the patient's concerns. This listening is often framed by a time constraint of 10 to 20 minutes in the examination room with the patient. It is not the actual amount of time the physician spends with the patient but the perceived quality of time that is critical to the patient's experience (Pollock and Grime, 2002). The physician conveys interest and concern for the patient by giving the impression of having time for the patient and being unhurried. Some patients feel disrespected by medical staffers who do not acknowledge the patient's own time commitments or personal beliefs and feelings (Lacy et al., 2004).

All interviews have content and a process. The content is the subject matter of the interview, or what is discussed. The process is rapport, or how the interview flows as the content is discussed. It is the nonverbal, emotional quality of the interaction. Rapport is a key to being a successful healer, especially in the current medical environment of technologic sophistication and managed-care limitations (see Chapter 12).

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