Sequenced questioning to elicit the patient's perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure.

BACKGROUND: During the medical interview, clinicians frequently overlook the patient's perspective on illness (PPI), ie, the patient's explanations and concerns about the presenting symptoms and expectations for the encounter. Without special efforts, the PPI surfaces spontaneously in only about one fourth of medical interviews. We determined whether asking the patient a series of sequenced questions would elicit the PPI and what effect such questioning would have on patient and physician satisfaction and on the length of the clinical encounter. METHODS: Fifty-five interviews in a family practice clinic setting were studied by videotape and post-interview debriefings. On a random basis, 29 patients were asked sequenced questions at the end of the history, while 26 experienced usual medical interviews. Measures of patient and physician satisfaction were compared by descriptive statistics and the Mann-Whitney test for ordinal data. RESULTS: In response to sequenced questioning, 44% of patients revealed specific, significant concerns that had not been otherwise disclosed. Among patients without prior contact with their provider, satisfaction with the encounter was significantly higher when the sequenced questions were used than when they were not; perception of time spent in discussion with the physician was also higher. Paradoxically, resident physicians expressed lower confidence that they had helped the patient when the sequenced questions were used to elicit the PPI. CONCLUSIONS: Use of sequenced questions to elicit the PPI results in significant sharing of new information and increased patient satisfaction and requires only a modest investment of time.

Interviewing when family members are present.

The presence of family members at an office visit creates unique opportunities and challenges for the physician while interviewing the patient. The physician must address issues of confidentiality, privacy, and agency. Special skills are required to respectfully and efficiently involve family members, while keeping the patient at the center of the visit. A core set of interviewing skills exists for office visit interviews with family members present. These skills include building rapport with each participant by identifying their individual issues and perspectives, and encouraging participation by listening to and addressing the concerns of all persons. Physicians should also avoid triangulation, maintain confidentiality, and verify agreement with the plan. It may be necessary to use more advanced family interviewing skills, including providing direction despite problematic communications; managing conflict; negotiating common ground; and referring members to family therapy.