A positive relationship is associated with improved health outcomes.
- 1 The medical interview
- 2 Benefits
- 3 Patient-physician confidentiality
- 4 References
The medical interview
- See also: Medical history taking
A qualitative study suggested benefit from the following 8 attributes of the health care provider:
- "do the little things"
- "take time"
- "be open and listen"
- "find something to like, to love"
- "remove barriers"
- "let the patient explain"
- "share authority"
- "be committed"
A supportive relationship that has "warmth, attention, and confidence" can reduce the pain of irritable bowel.
It is not clear whether the physician should wear traditional attire.
Before the interview
Various methods of helping the patient prepare questions prior to the interview have been studied without strong effect.
Greeting the patient
One study of videotaped physician-patient encounters concluded that "physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior. Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names."
Collaborative agenda setting may reduce, "oh by the way," requests by patients at the end of the visit.
Hearing the patient's story
Although physicians frequently (3/4s of interviews) interrupt patients before the patient finishes listing their concerns. It is not clear that this interruption is bad. Not asking for the patient's concerns at all may lead to more concerns arising late in the interview.
After the patient finishing stating their chief concern, responding with "Is there something else you want to address in the visit today?" rather than "Is there anything else you want to address in the visit today?" may decrease patients' unmet concerns.
Engaging the patient
Patient activation can be measured with the "Patient Activation Measure".
Readiness to change can be measured by the Readiness to Change Ruler or by the University of Rhode Island Change Assessment (URICA) questionnaire based on the Transtheoretical Model of Change. The URICA is 23 or 32 items and a 12 item "'Readiness to change" version has been developed. The Ruler correlates with the full questionnaire and predicts behavioral intentions.
Health literacy can be assessed.
The length of the visit
There is not enough time during the typical doctor-patient visit to cover all concerns in spite of the increasing length of visits. Increased numbers of medical problems or concerns brought by the patient interfere with quality of care. Preventive care alone, if coordinated by the doctor rather than delegated, requires more time than available.
Facilitating recall of information
The role of the computer during the interview
Most patients do not mind the physician seeking online information and not appearing to be "all knowing".
Oh, by the way
The "by-the-way” syndrome is the raising of a new problem by the patient at the end of the interview. Starting the interview with careful eliciting of the patient's agenda may avoid this problem. However, when "by-the-way" occurs, the nature of the problem is usually psychosocial whereas the physician usually reponds with a biomedical reply.
In general, communications between patient and physician are privileged and cannot be brought up as part of a court proceeding. There are exceptions for reporting certain contagious diseases, child abuse, and other specific events. In the U.S., privileged information is protected by the the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA).
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