Gathering Information

from patient
Dr Sow Chew Fei
Clinical Sciences Division
Introduction of Calgary-Cambridge Guide :
Interviewing the Patient

Gathering information

Your first session with
a simulated patient

Interviewing the simulated patient (SP) about a
simple medical problem.
receive feedback from the SP regarding your
performance and how you have made them feel.

What are simulated
patients ?
Simulated patients (SPs) are role players who effectively train
medical students in communication and diagnostic/clinical
skills.

monitoring of students performance and standardisation of
clinical examinations (OSCE).

SPs are either professionally trained actors playing the part of
patients, or may be volunteer simulators who were not
members of the acting profession - anyone from the
community !


By the end of the session, you should be able to:


Address patients concerns as well as the medical
agenda.
Demonstrate active listening
Use appropriate questioning skills (open and closed
questions).
Use signposting, responding to verbal and non-
verbal cues, clarifying

Gathering information for
1. Diagnostic purposes
a. A good history is the fundamental basis for
establishing a diagnosis in most patients
b. > 80% of diagnosis is made on history alone
(Hampton et al.1975)

2. Assessment before discharge
(house environment, care-taker, etc)

3. Assessment during follow-up visits
(hypertension, diabetes, post operation, etc)

Gathering information has 3 domains :

Content
(what you discuss and
record)
Perception
(What you think and
feel)
Process
(How you
communicate)
Content
Explore
patients
problem
Patients
perspective
Providing
structure to the
consultation
issues of your
discussion
sequence of events
symptom analysis
relevant system review
Ideas
concerns
expectations
feelings
effect of problem on
patients life
past medical problems
medication taken
family & social
circumstances
Explore patients problem

Encourage patient to tell the story
Establish dates & sequence of events in a chronological order
Begin with open-ended questions and proceed to closed
questions
Prioritise problem list in order of importance

Questioning Skills
Open-ended questions Begin an interview Could you tell me more about the
pain when the symptom first started?

Closed-ended questions are valuable for defining purposes and for establishing
definite events Was that yesterday evening ?

Escalating questions can be useful to pursue points of importance: Is there
anything else you want to tell me ?

Compound questions - Do you have vomiting, diarrhea and stomach pain ?

Leading questions make presumptions. Try to avoid.

Asking potentially offensive questions - Always explain why you need to ask
Im sorry to have to ask about this, but this is relevant because .

Patients perspective

Determine, acknowledge and appropriately explore:
Patients ideas and concerns
Patients expectations
How each problem affects the patients life

Encourage expression of the patients feelings

Providing structure to the consultation

Structure interview in logical sequence and in
different components (will be taught in Sem 2)

Summarise at the end of a specific part of the
interview

Attend to timing

Content
(what you discuss and
record)
Perception
(What you think and
feel)
Process
(How you
communicate)
Process
involves HOW you communicate with
the patient.

helps in building and solidifying your
relationship with the patient.



Process four components..
1. Listen show that you listen
2. Clarify
3. Demonstrate appropriate non-verbal behaviour
- includes posture, proximity, body movement,
facial expression etc
- Demonstrate confidence
- Pick up patient's non-verbal cues (body language, speech,
facial expression )
4. Explore
- Summarise periodically
- Use concise and easily understood language. Avoid jargon
- Signposting

Listening Skills
Listening vs hearing

We were given two ears but only one mouth, because listening is twice as hard
as talking."

Five key elements of active listening:

o Pay attention (eye contact, observe speaker language, refrain from side language)
o Show that you are listening (Nod, un huh, what did you do then)
o Provide feedback (paraphrasing What I am hearing is, summarise)
o Defer judgment (dont interrupt or assume, avoid bias)
o Respond appropriately (Treat the patient as he would want to be treated)


Signposting
Explain the next element of the interview to the patient before you move
from one section of the interview to another. It explains the rationale and
purpose of the next section.

Now, I would like to go through some questions regarding your lifestyle.

Explains your thoughts and needs to the patient


Content
(what you discuss and
record)
Perception
(What you think and
feel)
Process
(How you
communicate)
Perception
What you think and feel.
help you in clinical reasoning mainly from the content you have
gathered.
Accept patients views and feelings non-judgmentally
Empathise and acknowledge patients feelings & predicament
Provide support.
Express concern, understanding, willingness to help
Deal sensitively with embarrassing and disturbing topics and
physical pain


Thank
you


Please read page 38 Practical
Pointers in Communication during
Medical Interview in the
communication skill manual in e-
learning portal