Patient interview techniques: invite, listen, summarize

We had a Foundations of Doctoring session yesterday afternoon that focused on developing patient interview skills. The point of the session was to practice three specific interviewing techniques: inviting, listening, and summarizing. Then, in a group of four students and two facilitators, each of us took turns interviewing a standardized patient while the other three students watched and provided feedback.

Inviting refers to prompting the patient to talk by asking opened ended questions rather than yes/no questions:

"So, what can I do for you today?"
"How does that pain affect your daily life?"
"What do you think might be going on here?"

These types of open questions invite the patient to say what is on his or her mind rather than answering targeted questions that may or may not have anything to do with the real matter at hand. The idea is that this approach "humanizes" the patient rather than relating to the patient as a collection of symptoms to be solved. Also, the doctor may catch something that otherwise might have gone unnoticed. All of this may seem self-evident, but when I'm actually sitting in front of a patient, it's surprising how easily I can fall into the trap of peppering the patient with symptom-specific questions.

Listening refers to both verbal and non-verbal cues. Most of these are sub-conscious facial expressions (e.g. raising eyebrows, narrowing eyes) or body language (e.g. posture mirroring, nodding head), or simply keeping quiet.

I had the most trouble with summarizing because it felt so unnatural to constantly repeat what the patient had just said. For example, if the patient tells me that her foot started tingling two weeks ago and started hurting one week ago, the instructors would want me to say something like, "So, what I'm hearing is that your foot started tingling two weeks ago and started hurting one week ago." Then they would expect the patient to enthusiastically exclaim, "Yes, that's right, Doc!" I understand that the purpose of this is to make the patient feel like he or she is being heard correctly, but if done the wrong way, constantly repeating what the patient just said can make me look like a dufus. I did my best to make it work within my own personality and within the context of the conversation.

Overall, I found the patient interview training to be very helpful.

So, next time you're at the doctor's office, pay attention to how the doctor is communicating with you. I'm curious to hear people's real world experiences.