The patient interview

As I continue along my medical school education journey, I am really starting to realize one of the real ‘arts’ of medicine is the patient interview.

The Sanford SOM does a great job teaching medical students the basics of a good patient interview. During one of these teaching sessions I was stunned to learn that may doctors do not get around to addressing the patient’s main concerns during the patient interaction. How could this happen? When the patient calls in to setup an appointment, don’t they tell you the main concern they are having? I guess it’s not really that simple.

One gold nugget of interviewing knowledge we have gained during our patient interview sessions, is to ask the patient an obvious open ended question to get the interview rolling. Ask a question such as, “What brings you into the clinic today?” or “How can we help you today?” This may seem silly, as the chief complaint is probably already on the chart when you walk in, but it’s amazing how quickly the patient will tell you the main points they want covered in the visit and how much time it really saves.

After following a couple doctors who cut off the patient very quickly and try to do all the talking themselves, I am really amazed at the lack of basic interviewing skills these physicians have. While they are extremely smart clinicians who really cared about their patients, the fact that they didn’t acknowledge obvious patient concerns during the interview worried me.

For example, construction worker in his early 30’s comes into clinic with a chief complaint of headaches. He is being seen again after having come into clinic with this complaint last month. Last visit, the doctor diagnosed migraines, ordered a two medications, and highly recommended a CT scan of the brain. This week, the patient comes in stating that he has been having headaches of the same frequency and duration. The quick acting medication works, but he has not been taking the preventative medication, and he didn’t get the CT done. During the interview, the doctor is trying to gather information using almost all yes/no or very short answer questions, while at the same time lecturing the patient at the importance of getting that CT scan done. During this time the patient seems to almost offer excuses why he didn’t get the scan done but at the same time trying to voice these as concerns. He stated that this is a very stressful time of year for him, he hasn’t been sleeping well, and that he thinks he may have something wrong in his chest. The doctor did not acknowledge any of these, brushing them all off very quickly with the response, “I know.” Then fixated on the caffeine usage and the importance of the CT scan.

I can tell you right now, I am not a doctor. But, it seems to me that just asking about the stress, sleep, and worries about the chest may have eased the concerns of the patient and wouldn’t have taken the doctor too much longer. To me, it seemed like stress, problems sleeping, and the chest worries easily could have been the things causing the headaches. But again, I’m no doctor.

At the start of our patient interview classes, I thought we were really wasting our time. I thought it really couldn’t be that hard to address our patient’s concerns and that teaching us a standardized patient interview was a waste of time. I also thought that doctors were probably more competent at fishing out a patient’s underlying concerns better than our instructors and the statistics would have us believe. After a few clinicals, I can say that I am glad I’ve been getting this patient interview training. I have been amazed at the basic patient interview skills some physicians lack, and really appreciate the ‘art’ of the patient interview.