Nature and Goals of the Interview
Most clinicians rate the patient’s medical history as having greater diagnostic value than either the physical examination or results of laboratory investigations (Rich, 1987). The clinical adage that about two-thirds of diagnoses can be made on the basis of the history alone has retained its validity despite the technological advances of the modern hospital. An accurate history also provides focus to the physical examination, making it more productive and time efficient. Clinical hypotheses generated during the interview provide the basis for a cost-effective utilization of the clinical laboratory and other diagnostic modalities.
The diagnostic utility of the interview is complemented by its therapeutic power. As the medium through which a positive relationship is established between the doctor and the patient, an empathic, patient-centered interview can bolster the patient’s sense of self-esteem and lessen the feelings of helplessness that often accompany an episode of illness. The therapeutic alliance forged during the clinical encounter provides the foundation for ongoing patient care and education.
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The student may wonder how the medical interview differs from other conversations and why special skills are required. It is the sense of direction that distinguishes the medical interview from the casual conversations of most social encounters. Fundamentally, the medical interview is a purposeful conversation undertaken with a set of goals and priorities clearly maintained in the physician’s mind. Its direction reflects the respective needs of both participants—patient and physician. The patient enters the interview seeking relief from the discomforts and uncertainties of illness, while the physician actively conducts the interview in order to clarify the patient’s problems and derive diagnostic and therapeutic plans for the patient’s benefit. During the interview the patient’s need to have his or her story heard and suffering understood is balanced by the physician’s need to know and understand as much as possible about the patient and his or her problems (Engel, 1988). For most physicians, the most difficult aspect of interviewing patients is maintaining a balance between the patient’s and the physician’s agenda; between actively directing the encounter and facilitating the patient’s spontaneous report of history. At its best, the interview becomes a dialogue between two people driven toward a common goal.
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Category: WHO
