Clinical Interview

<p><em>The Clinical Interview</em> offers a new perspective on the patient encounter. Interpreting decades of evidence-based psychotherapy and neuroscience, it provides 60 succinct techniques to help clinicians develop rapport, solicit better histories, and plan treatment with even the most challenging patients. </p><p>This book describes brief skills and techniques for clinical providers to improve their patient interactions. Although evidence-based psychotherapies are typically designed for longer specialized treatments, elements of these psychotherapies can help clinicians obtain better patient histories, develop more effective treatment plans, and more capably handle anxiety-provoking interactions. Each chapter is brief and easily digestible, contains sample clinical dialogue, and provides references for further reading. These skills help clinicians practice more effectively, more efficiently, and with greater resilience. Whatever your clinical specialty or role, whether you are a trainee or an experienced clinician, <i>The Clinical Interview </i>offers practical wisdom and an entirely new way to think about the clinical encounter.</p><p>The Clinical Interview will be of great use to any student in a health-related field of study or a healthcare professional interested in refining their interviewing skills. It will help anyone from emergency medical technicians, nurses, and physician assistants, to nurse practitioners and physicians to build more meaningful patient relationships. </p> <p><strong>SECTION I. BUILDING RAPPORT</strong></p><p>1. <strong>Elicit one goal</strong></p><p>Be more efficient by learning the patient’s agenda</p><p>2. Validate three different ways</p><p>Be authentic in your validation by expanding the ways in which you can agree with the patient</p><p>3. Mirror the patient’s language to build rapport</p><p>Use the patient’s phrasing to avoid misinterpretation</p><p>Jodi Zik, MD</p><p>4. Use the power of "and"</p><p>Introduce "and" rather than "or/but" statements to your interview to establish rapport, validate the patient’s experience, and facilitate change</p><p>Ashley Curry, MD</p><p>5. Redirect demanding patients</p><p>Reinforce that the patient, like everyone, is entitled to good medical care</p><p>6. Be silent</p><p>Use active silence to support the patient’s emotional expression</p><p>Jesse Markman, MD, MBA</p><p>7. Be playful</p><p>Introduce playful irreverence to challenge rigidity, signal affection, and build social connection</p><p>Amy Dowell, MD, and Alexia Giblin, PhD, CEDS</p><p>8. Handle the hollering with a calming question</p><p>Through tone of voice, active listening, and setting limits, invite a conversation to de-escalate a shouting patient</p><p>Thomas Dunn, PhD</p><p>9. Recognize your own emotions</p><p>Identify and process your countertransference during the interview to improve the patient’s well-being (and your own)</p><p>Jonathan Buchholz, MD, Lionel Perez, MD, Lindsay Lebin, MD, and Heidi Combs, MD, MS</p><p>10. Reflect the patient’s statements</p><p>Use a well-timed reflection to disrupt a negative thought spiral</p><p>Jesse Markman, MD, MBA</p><p>11. Introduce progressive muscle relaxation</p><p>Give the patient an active task to change their emotional experience</p><p>Jesse Markman, MD, MBA</p><p>12. Use emotional validation to manage negative countertransference</p><p>Disarm your negative emotions and humanize your patients </p><p>Melanie Rylander, MD</p><p>13. Consider fear when the patient is angry</p><p>Assess what the patient might be afraid of when they become upset</p><p>14. Validate the patient’s perspective of where they are now and where they need to go</p><p>Understand and support the patient’s reality and goals to enhance motivation for treatment</p><p>15. Share how you feel</p><p>Put your own feelings into words to reset a difficult conversation</p><p>16. Agree to disagree</p><p>De-escalate an argument by repeating this short phrase</p><p>17. Be honest about your limitations</p><p>Relieve yourself of unobtainable expectations and reset the conflictual encounter</p><p>SECTION II. TAKING A HISTORY</p><p>18. Be curious</p><p>When curious about what a patient has said, ask more questions to obtain useful information and show the patient that you are interested</p><p>Rachel Glick, MD</p><p>19. Prioritize information you need right now</p><p>Shift your line of questioning without shifting the topic</p><p>David Kroll, MD</p><p>20. Use open-ended questions for sensitive topics</p><p>Invite greater honesty and avoid a sense of judgment through open-ended questions</p><p>21. Attend to affect</p><p>Emphasize the patient’s emotional words for a richer history </p><p>22. Validate and move</p><p>Use validation as a transitional tool in the unwieldy interview</p><p>23. Write a timeline</p><p>Organize chaotic histories and validate the patient’s experience</p><p>24. Ask "How come?" instead of "Why?"</p><p>Vary your phrasing slightly to improve the tone of the interview</p><p>25. Observe caregivers’ nonverbal cues</p><p>Gather information from caregivers to increase accuracy and efficiency in diagnosis of cognitive disorders</p><p>Joleen Sussman, PhD, ABPP</p><p>26. Roll with impaired reality testing</p><p>Provide a validating and grounded interview for patients with psychotic symptoms</p><p>Erin O’Flaherty, MD</p><p>27. Ask for help understanding</p><p>Frame an open-ended question as a plea for the patient’s assistance</p><p>28. Collect the social history first</p><p>Re-order the traditional interview to better engage reluctant patients</p><p>Sarah Schrauben, MD</p><p>29. Ask about family history</p><p>Use the family history as a lead-in to sensitive questions</p><p>30. Wonder aloud with the patient</p><p>Use and re-use a brief, non-committal phrase to explore the patient’s history and treatment options</p><p>SECTION III. MAKING AN ASSESSMENT</p><p>31. Track symptoms and behaviors</p><p>Keep a log to aid diagnosis and begin treatment</p><p>32. Find the key worry</p><p>Consider the anxious patient’s most important worry in making the diagnosis</p><p>33. Consider past healthcare encounters</p><p>Ask how patients’ past healthcare experiences may inform their current experience</p><p>34. Identify what is solvable</p><p>Focus on concrete objectives that you and the patient can realistically solve together</p><p>35. Talk about traits, not diagnosis</p><p>Think of maladaptive thoughts and behaviors on a spectrum of normal</p><p>Jodi Zik, MD, and Melanie Rylander, MD</p><p>36. Label the patient’s affect</p><p>Help manage the patient’s emotional experiences by putting it into words</p><p>Edward MacPhee, MD</p><p>37. Talk about the mind-body connection</p><p>Connect psychiatric and medical symptoms to encourage openness to mental health interventions</p><p>Thida Thant, MD</p><p>38. Emphasize function over feeling in chronic illness</p><p>Shift the visit’s focus to capability to reinforce the patient’s self-efficacy and agree on achievable outcomes</p><p>39. Consider the social history in your assessment</p><p>Apply the social history as a tool for understanding the patient’s diagnosis and treatment</p><p>Jodi Zik, MD</p><p>40. Remind the patient what is not working</p><p>Ask how the patient feels about their current behaviors in order to motivate change</p><p>41. Ask about medication side effects</p><p>Assess experiences of side effects when medications are seemingly ineffective</p><p>Vivian Cheng, PharmD, and Jeffrey Clark, PharmD, BCPP</p><p>42. Ask the "why" about online information</p><p>Focus on the patient’s motivations for sharing information brought to the encounter</p><p>43. Recall the patient’s strengths</p><p>Consider how the patient’s abilities can be used in the service of their health</p><p>44. Accept or change</p><p>Simplify the possible outcomes to help the patient stop venting and decide on action</p><p>SECTION IV: PLANNING TREATMENT</p><p>45. Set the stage</p><p>Spend one visit preparing to make significant treatment changes</p><p>46. Fish for change talk</p><p>Guide the patient into talking about behavior change more quickly</p><p>Alex Kipp, MD, MALS</p><p>47. Imagine the future</p><p>Envision the patient’s healthy life in order to prioritize treatment goals</p><p>48. Prescribe change</p><p>Use a prescription pad to emphasize non-pharmacologic interventions</p><p>49. Ask the patient’s beliefs regarding medications</p><p>Understand what patients think medications will do for them to clarify treatment and improve adherence</p><p>50. Anticipate challenges</p><p>Be specific in planning ahead and removing obstacles to treatment success</p><p>51. Experiment with change</p><p>Introduce change as something the patient can simply try out—no commitment necessary!</p><p>52. Operationalize improvement</p><p>Be specific with the patient about what "better" means</p><p>53. Frame limit-setting from the patient’s perspective</p><p>Consider how setting effective limits will improve the patient’s care</p><p>David Kroll, MD</p><p>54. Share difficult decisions</p><p>Give the patient options when collaborating on a treatment plan with which the patient is reluctant to engage</p><p>55. Define efficacy for medication changes</p><p>Understand the patient’s goals and how they will know if a medication change is working</p><p>56. Help patients resist urges</p><p>Review how patients can refrain from acting on unhelpful impulses</p><p>57. Accept ambivalence: "It’s okay not to change"</p><p>Allow patients to acknowledge and accept when they are not ready to change</p><p>Jodi Zik, MD, and Melanie Rylander, MD</p><p>58. Plan for a crisis</p><p>Write a three-step crisis plan to anticipate patients’ triggers and coping skills</p><p>59. Normalize challenges</p><p>Validate that treatment is difficult for many patients</p><p>60. Reinforce the positive</p><p>Encourage healthy decision-making and adherence with plentiful encouragement</p>