Extend a second question or comment, encouraging the patient to talk.
4.
Allow the patient to respond without interrupting, perhaps by employing silence, nods, or small facilitative comments, encouraging the patient to talk while the physician is listening.
5.
The physician should periodically summarize his or her understanding of the history to confirm accuracy.
6.
Expressions of empathy and understanding at the completion of the interview along with a summary of the planned assessments and recommendations will facilitate the closure of the interview.
Attentiveness, rapport, and collaboration characterize good medical interviewing techniques. Open-ended questions (“How are you doing?” “How are things at home?” “How does that make you feel?”) are generally desirable, particularly when they are coupled with good listening skills (46).
Premature closure of an interview and an inability to get complete information from the patient may occur for several reasons. They may result from failure to recognize the patient’s particular concern, from not providing appropriate opportunity for discussion, from the physician’s discomfort with sharing the patient’s emotion, or perhaps from the physician’s lack of confidence that he or she can deal with the patient’s concern. One of the principal factors undermining the success of the interview is lack of time. This is a realistic concern perceived by physicians, but skilled physicians can facilitate considerable interaction even in a short time by encouraging open communication (47).
Some patients lack accurate information about their illnesses. Incomplete or inadequate understanding of an illness can produce dissatisfaction with medical care and increased anxiety, distress, and coping difficulties, resulting in unsuccessful treatment and poor treatment response. As patients increasingly request more information about their illnesses and more involvement in decisions about their treatment, and as physicians attempt to provide more open interactive discussions, there is an even greater need to provide clear and effective communication. Although patients vary in their levels of intellectual finesse, medical sophistication, anxiety, denial, and ability to communicate, the unfortunate occurrence of impaired patient comprehension can be the product of poor physician communication techniques, lack of consultation time, and in some cases, the withholding of information considered detrimental to patient welfare (48).
If clinical findings or confirmatory testing strongly suggest a serious condition (e.g., malignancy), the gravity and urgency of this situation must be conveyed in a manner that does not unduly alarm or frighten the individual. Honest answers should be provided to any specific questions the patient may want to discuss (49,50).
Allowing time for questions is important, and scheduling a follow-up visit to discuss treatment options after the patient has an opportunity to consider the options and recommendations is often valuable. The patient should be encouraged to bring a partner or family member with her to provide moral support, to serve as another listener to absorb and digest the discussion, and to assist with questions. The patient should be encouraged to write down any questions or concerns she may have and bring them with her to a subsequent visit; important issues may not come to mind easily during an office visit. If the patient desires a second opinion, it should always be facilitated. Physicians should not feel threatened by patient attempts to gain information and knowledge.
Valuable information can be provided by interviews with ancillary support staff and by providing pamphlets and other materials produced for patient education. Some studies demonstrated that the use of pamphlets is highly effective in promoting an understanding of the condition and treatment options. Others showed that the use of audiotapes, videotapes, or information on an Internet site has a positive impact on knowledge and can decrease anxiety (51–53).
There are numerous medical Web sites that can be accessed, although the accuracy of the information is variable and must be carefully reviewed by physicians before recommending sites to patients. Physicians should be familiar with Internet sources offering accurate information and be prepared to provide the addresses of these sites if the patient expresses interest (54).
The relationship between the patient and her physician, as with all aspects of social interaction, is subject to constant change. The state of our health is dynamic and it affects our ability to communicate with others, including conversations between patients and physicians. Open communication between patient and physician can help achieve maximum effectiveness in diagnosis, treatment, and compliance for all patients.
Talk to the heart, speak to the soul.
Look to the being and embrace the figure’s form.
Reach deeply, with hands outstretched.