Identifying Medical Interview Behaviors that Best Elicit Information from Patients in Clinical Practice

Abstract

Many textbooks indicate the desirability of using specific medical interview behaviors to obtain information from patients, although little evidence has been presented. The aim of this study is to investigate the relationships between the use of medical interview behaviors and the amount of information obtained. The behaviors studied included: open-ended questions, facilitation (comments or interviewer behavior that encourages the patient to continue talking), the open-to-closed cone (the gradual narrowing of focus from an initial nondirective approach to a more direct exploration), summarization (providing the patient with an explicit verbal summary of the information gathered thus far), and surveying problems. The subjects were 315 patients who visited an outpatient facility. These medical interviews were videotaped and reviewed by a trained rater using the Takemura Medical Interview Rating Scale, which was developed to assess the use of particular medical interview behaviors and to measure the amount of information obtained from patients regarding their chief physical complaints. Significant positive relationships were found between three particular interview behaviors and the amount of information obtained: facilitation, the open-to-closed cone, and summarization. These positive relationships were still present after adjusting for other medical interview behaviors used, and after adjusting for the time duration of the medical interviews (F = 15.3, p < 0.0001; F = 40.1, p < 0.0001; F = 5.57, p = 0.019, respectedly). This study reveals a positive relationship between three specific medical interview behaviors (facilitation, the open-to-closed cone, and summarization) and the amount of information obtained in a real clinical practice setting.

Interobserver agreement on signs and symptoms of patients with acute febrile illness

“…The attempt to include a very large set of information would result in an unfeasible tool and disrupt clinical reasoning. For example, when assessing a single symptom, the formulation of diagnostic hypotheses and/or their rejection can require information regarding the symptom's onset, intensity, duration, P pos , mean positive agreement proportion; P neg , mean negative agreement proportion; Po, total observed agreement proportion a Classified as macular (68/78) or macular-papular (10/78) frequency, quality, context, location, relief, and worsening factors [23]. This kind of essential information cannot be anticipated in a standardized form.…”

Three strategies for bridging different levels of analysis and embracing the biopsychosocial model.

“…Investigations of "the medical encounter" would advance psychological theory and also have practical value. For example, Takemura, Atsumi, and Tsuda (2007) recently identified several interpersonal techniques that predict the amount of information gathered in real clinical encounters. These and related studies demonstrate how personality and social psychological approaches can identify what medical educators need to teach to improve the outcomes of care.…”

‘Tell Me About Your Troubles’: Description of Patient-Physiotherapist Interaction During Initial Encounters

“…Non-vocal actions such as nodding without interrupting the patient (i.e. facilitation) or summarizing the information gathered so far by clinicians seem to encourage the patient to continue talking about his/her concerns and indicate that the patient's concerns are heard and understood (Takemura et al, 2007). In our sample, physiotherapist B clearly adopted this approach and constructed the next question on the basis of the patient's discourse, whereas physiotherapist A, following more closely the physiotherapy patient record, tended to use yes/no questions and 'okay' as a resource (Beach, 1995).…”