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patient to give a detailed response, allowing the patient to express
himself in his own words, e.g.
What would you like to discuss today?
or
What brings you
here today?
The patient will then produce his/her
opening statement.
The
opening statement
is when the patient reveals the issues
he/her wishes to discuss. Interrupting the opening statement (which is
something many doctors do) means that fewer complaints are elicited
and vital signs and symptoms may be missed, possibly resulting in
misdiagnosis. Instead, doctors should use active listening skills to de-
termine the salient points of the statement in order to set the agenda
for the consultation, using the verbal and non-verbal cues (looking up-
set, sounding frustrated, etc.) that determine both the physical and
emotional state of the patient.
Setting the patient’s agenda, as opposed to carrying out the doc-
tor’s agenda, is important. Based on the salient points of the opening
statement, the doctor must decide on a schedule or structure to the en-
counter, e.g.
Shall we start with … and then we’ll
come back to the
problems you’ve been having with …?
Doctors should not forget to
obtain the patient’s agreement on the agenda, e.g.
… if that’s OK with
you?
When interviewing a patient in certain contexts (e.g. if they are
suffering from respiratory problems, are highly stressed, or are in
A&E), it is better to use a
closed questioning technique
. Closed
questions require a one-word answer (Yes, No), without encouraging
the patient to express themselves in any detail. Used inappropriately,
however, this question type can be quite restrictive. Nonetheless, good
non-verbal communication can run closed into open question.
Other kinds of questions are:
–
multiple:
This is where several questions are asked at the same
time, making it harder to focus on the answer required, e.g.
Does
the itching always occur in the same place, and how
bad is it?
–
leading
: This is where the question is phrased to elicit a particular
answer, e.g.
Does the
itching always start first thing in the morn-
ing
? (as opposed to
When does the itching start?)
–
tag:
These are a form of closed and leading question, character-
ized by the ‘tag’ at the end of the sentence. The tag is formed by
the opposite form (positive or negative) of the auxiliary verb in