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Initial Interview
The initial interview with a patient can be a very intimidating interaction between the patient and the practitioner. A patient will be walking into the clinic and will be experiencing a variety of symptoms as well as functional limitations. It is up to the clinician to be able to not only understand what the patient is experiencing, but what is the solution to help them with their problems.
Sometimes we need a plan to be able to extrapolate information efficiently, so we can better formulate a plan of care that will best address the patients needs and help them achieve their goals. There are various strategies that can implemented during the initial interview, that will ultimately help the clinician be more successful and establish a strong therapeutic alliance.
Suggested strategies include:
Strategies
- Active Listening
The initial interview is a time where the clinician can gather pertinent information to help guide the initial evaluation. The patient is ultimately the individual who holds all information. However, too often patients are interrupted too quickly and do not have a change to ‘tell their story’. A study indicated that 27 out of 40 encounters with a primary care professional, the patient was interrupted after a median of 11 seconds.1 11 seconds!? Imagine someone trying to tell you what they are experiencing in that short span of time. The patient is the storyteller, and we need them to give us as much information as possible, so we can better help them.
- Communication and Language
Active listening is one component to being an effective communicator. Other attributes include understanding verbal/non-verbal communication, open-end versus close-ended questioning, being succinct, empathetic, and ability to build trust.
Specific words that we convey to a patient can have a huge impact and can influence the rehabilitation process. The choice of words can positively or negatively ultimately desired clinical outcome.2 Patients can misinterpret information and thus, changes their belief system, values, and expectations to receiving care. Therefore, we should learn how to frame our words differently to help the patient understand what they are experiencing. It becomes paramount that we use our words carefully as the patient’s perception should be taken into consideration.2
- Motivational Interviewing
Motivational interviewing is a collaborative conversation between the patient and the practitioner for strengthening an individual’s own motivation and commitment (Miller). There are certain elements that encompass motivational interviewing in which will be beneficial to strengthening the bond between the patient and the practitioner (Miller):
- Open-ended questioning
- Affirmations
- Reflective listening
- Summarizing
The use of open-ended questioning allows the opportunity for patients to elaborate more on what they are experiencing.3 Too many closed-ended questions limit the answers that can be provided and should be reserved for confirming information. Affirmations involve positive statements made to the patient demonstrating interest and understanding what the patient is experiencing.3 Reflective listening can allow the patient to share their own personal experiences and can also further test initial working hypotheses.3 Further insights can help confirm the patient’s belief system and understanding of their own perception. Summarizing allows the clinician to synthesize the data and learn how to use a more insightful approach to generate initial working hypotheses that will be tested throughout the episode of care.
The initial interview will provide the clinician with approximately 80% of the information needed to help guide the rest of the episode of care. Interviewing a patient should be “received” and not “taken”.
An efficient gathering of history, and a thorough physical examination can lead to a positive therapeutic effect, short-term decrease in pain, catastrophization, improved functional mobility, and decreased sensitivity to pressure.4 This may yield the most significant changes when compared to the physical examination alone.4
Summary
Therefore, it becomes imperative we learn from our patients and allow them to be active participants during the rehabilitation process. Allowing our patients to be active participants will ultimately help to establish:
We should remember that healthcare is highly individualized and needs to be patient focused. Allowing the patient to participate in their own episode care, will lead to improved outcomes and promote long-term self-management.
Authored by Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT
References:
- Ospina NS, Phillips KA, Rodriguez-Gutierrez R, Castaneda-Guarderas A, Gionfriddo MR, Branda ME, and Montori VM. Eliciting the patient’s agenda- analysis of recorded clinical encounter. JGIM, 2019:36-40.
- Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018 Jul; 48(7):519-522.
- Miller and Rollnick. Motivational Interviewing: Helping People Change. 3rd ed Guilford Press. 2013.
- Louw A, Goldrick S, Bernstetter A, Van Gelder LH, Parr A, Zimney K, and Cox T. Evaluation is treatment for low back pain. Journal of Manual & ManipulativeTherapy, 2020; DOI: 10.1080/10669817.2020.1730056.