Chapter 3—Key Points
This section discusses key points about the communication frame of reference, expressing your thoughts, and
process and techniques. feelings.
• A health interview is a structured interaction between
you and the patient. The terms governing this • To further enhance communication, avoid the ten traps
interaction should be stated clearly at the start of the of interviewing. These nonproductive verbal messages
interview so that openness and trust are facilitated. Your include:
mutual goal is the patient’s optimal health. • Providing false assurance or reassurance,
• Communication is the exchange of information so that • Giving unwanted advice,
each person clearly understands the other. • Using authority,
Communication is based on behavior, conscious and • Using avoidance language,
unconscious, remembering that all behavior has • Engaging in distancing,
meaning. • Using professional jargon,
• The process of communication includes sending • Using leading or biased questions,
and receiving information. When exchanging • Talking too much,
information, both individuals engage in verbal and • Interrupting,
nonverbal communication, which can affect • And using “why” questions.
communication. • Pay attention to nonverbal modes of communication,
• Internal factors are specific to the examiner. Four which include:
internal factors promote good communication: liking • Physical appearance,
others, expressing empathy, the ability to listen, and • Posture,
self-awareness. • Gestures,
• External factors relate mainly to the physical setting. • Facial expression,
You can foster good communication with certain • Eye contact,
external factors, such as by ensuring privacy, • Voice,
preventing interruptions, creating a conducive • And touch.
environment, arranging equal-status seating, • Nonverbal communication is important in establishing
wearing appropriate attire, and documenting rapport and conveying information while providing
responses via note taking or an electronic clues to understanding feelings.
health record without interfering with the
conversation. This section presents critical points about communication
• The interview has three phases: an introduction, a in special situations.
working phase, and a closing. • Modify communication techniques based on each
• During the first phase, begin the interview by patient’s developmental stage, including parents,
introducing yourself and your role. infants, young children, adolescents, and older adults.
• During the working phase, gather data. Start with • Learn to communicate effectively with patients who
open-ended questions, which ask for narrative have special needs, such as those with a hearing
information. Then use closed or direct questions, impairment, acute illness, intoxication or substance
which ask for specific information in short, one- or abuse, and those who are sexually aggressive, angry,
two-word answers. anxious, violent, or in tears.
• During the closing, signal that the interview is • When a patient comes from a different culture, modify
ending, which gives the patient one last chance to your approach as needed. Behaviors that one culture
share concerns or express himself or herself. Also views positively may have different, possibly negative,
briefly summarize what you learned during the connotations in another culture.
interview. • Be culturally sensitive to LGBTQ patients and do not
• You can use different types of verbal responses to engage in heterosexism. Do not make assumptions based
assist the narrative and help gather data. Each response on the patient’s appearance. Ask new patients what their
plays a role in the interview process, but practice is preferred pronoun is and be open, non-judgmental, and
needed to use them effectively and move among them empathetic when speaking to LGBTQ patients.
smoothly. • For a patient with limited English proficiency or
• Through facilitation, silence, reflection, empathy, hearing impaired, use a sign language interpreter or a
and clarification, you react to the facts or feelings the bilingual team member or a trained medical
patient has communicated. Your response focuses on interpreter whenever possible. Avoid using a family
the patient’s frame of reference. member or close friend as an interpreter because this
• Through confrontation, interpretation, explanation, violates the patient’s confidentiality and they may edit or
and summary, your response focuses on your own change the message.
Copyright © 2020 Elsevier Inc. All rights reserved.
This section discusses key points about the communication frame of reference, expressing your thoughts, and
process and techniques. feelings.
• A health interview is a structured interaction between
you and the patient. The terms governing this • To further enhance communication, avoid the ten traps
interaction should be stated clearly at the start of the of interviewing. These nonproductive verbal messages
interview so that openness and trust are facilitated. Your include:
mutual goal is the patient’s optimal health. • Providing false assurance or reassurance,
• Communication is the exchange of information so that • Giving unwanted advice,
each person clearly understands the other. • Using authority,
Communication is based on behavior, conscious and • Using avoidance language,
unconscious, remembering that all behavior has • Engaging in distancing,
meaning. • Using professional jargon,
• The process of communication includes sending • Using leading or biased questions,
and receiving information. When exchanging • Talking too much,
information, both individuals engage in verbal and • Interrupting,
nonverbal communication, which can affect • And using “why” questions.
communication. • Pay attention to nonverbal modes of communication,
• Internal factors are specific to the examiner. Four which include:
internal factors promote good communication: liking • Physical appearance,
others, expressing empathy, the ability to listen, and • Posture,
self-awareness. • Gestures,
• External factors relate mainly to the physical setting. • Facial expression,
You can foster good communication with certain • Eye contact,
external factors, such as by ensuring privacy, • Voice,
preventing interruptions, creating a conducive • And touch.
environment, arranging equal-status seating, • Nonverbal communication is important in establishing
wearing appropriate attire, and documenting rapport and conveying information while providing
responses via note taking or an electronic clues to understanding feelings.
health record without interfering with the
conversation. This section presents critical points about communication
• The interview has three phases: an introduction, a in special situations.
working phase, and a closing. • Modify communication techniques based on each
• During the first phase, begin the interview by patient’s developmental stage, including parents,
introducing yourself and your role. infants, young children, adolescents, and older adults.
• During the working phase, gather data. Start with • Learn to communicate effectively with patients who
open-ended questions, which ask for narrative have special needs, such as those with a hearing
information. Then use closed or direct questions, impairment, acute illness, intoxication or substance
which ask for specific information in short, one- or abuse, and those who are sexually aggressive, angry,
two-word answers. anxious, violent, or in tears.
• During the closing, signal that the interview is • When a patient comes from a different culture, modify
ending, which gives the patient one last chance to your approach as needed. Behaviors that one culture
share concerns or express himself or herself. Also views positively may have different, possibly negative,
briefly summarize what you learned during the connotations in another culture.
interview. • Be culturally sensitive to LGBTQ patients and do not
• You can use different types of verbal responses to engage in heterosexism. Do not make assumptions based
assist the narrative and help gather data. Each response on the patient’s appearance. Ask new patients what their
plays a role in the interview process, but practice is preferred pronoun is and be open, non-judgmental, and
needed to use them effectively and move among them empathetic when speaking to LGBTQ patients.
smoothly. • For a patient with limited English proficiency or
• Through facilitation, silence, reflection, empathy, hearing impaired, use a sign language interpreter or a
and clarification, you react to the facts or feelings the bilingual team member or a trained medical
patient has communicated. Your response focuses on interpreter whenever possible. Avoid using a family
the patient’s frame of reference. member or close friend as an interpreter because this
• Through confrontation, interpretation, explanation, violates the patient’s confidentiality and they may edit or
and summary, your response focuses on your own change the message.
Copyright © 2020 Elsevier Inc. All rights reserved.
