The Interview Process

As the physician talks with the patient, the natural flow of the conversation is itself a part of the diagnostic environment. How the patient interacts with the physician in the closeness and intimacy of the examination room is descriptive for how the patient relates with others outside the office context, whether at home or at work or at leisure and play.

During the interview, the physician's own feelings and intuitions can help the physician understand how the patient is dealing with the illness (Borrell-Carrio et al., 2004). Sometimes, in the scientific world of medicine, physicians may believe that keeping their own feelings out of the process is the best way to be objective and relevant. However, if the physician is mechanical and distant because of discomfort with personal sensitivity, the patient will quickly notice the distance.

Psychiatrist Harry Stack Sullivan (1954) observed that the work of the physician is to be a "participant-observer" in the process of the interview. The physician maintains a scientific observer perspective, while also being available and present to the patient as a fellow human in the journey of life. As the physician becomes more sensitive and aware of the interview process, there is the experience of "reciprocal emotion," the continuous reflecting of another's feelings. The openness of the interview is further enhanced by the physician "mirroring" the body posture of the patient, such as crossing a leg, leaning forward, or leaning back (see Chapter 12).

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