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When visitors are in the room, be sure to acknowledge and greet each one in irn, inquiring about each person's name and relationship to the patient.

lenever visitors are present, it is important for you to maintain confidentiality. Let the patient decide if visitors or family members should remain in ie room, and ask for the patient's permission before conducting the interview in front of them. For example, "I'm comfortable with having your sister stay for the interview, Mrs. Jones, but I want to make sure that this is also what you want" or "Would you prefer if I spoke to you alone or with your sister present?"

It is important to be attuned to the patient's comfort. In the office or clinic, be sure there is a suitable place other than the patient's lap for coats and belongings. In the hospital, after greeting the patient, ask how the patient is feeling and if you are coming at a convenient time. Look for signs of discomfort, such as frequent changes of position or facial expressions that show pain or anxiety. Arranging the bed to make the patient more comfortable or allowing a few minutes for the patient to say goodbye to visitors or finish using the bedpan may be the shortest route to a good history.

Consider the best way to arrange the room and how far you should be from the patient. Remember that cultural background and individual taste influence preferences about interpersonal space. Choose a distance that facilitates conversation and good eye contact. You should probably be within several feet, close enough to be intimate but not intrusive. Pull up a chair and, if possible, try to sit at eye level with the patient. Move any physical barriers between you and the patient, such as desks or bedside tables, out of the way. In an outpatient setting, sitting on a rolling stool, for example, allows you to change distances in response to patient cues. Avoid arrangements that connote disrespect or inequality of power, such as interviewing a woman already positioned for a pelvic examination. Such arrangements are unacceptable. Lighting also makes a difference. If you sit between a patient and a bright light or window, although your view might be fine, the patient may have to squint uncomfortably to see you, making the interaction more like an interrogation than a supportive interview.

Give the patient your undivided attention. Try not to look down to take notes or read the chart, and spend enough time on small talk to put the patient at ease.

Inviting the Patient's Story. Now that you have established rapport, you are ready to pursue the patient's reason for seeking health care, or chief complaint. Begin with open-ended questions that allow full freedom of response. "What concerns bring you here today?" or "How can I help you?" Note that these questions encourage the patient to express any possible concerns and do not restrict the patient to a limited and minimally informative es" or "no" answer. Listen to the patient's answers without interrupting. ter you have given the patient the opportunity to respond fully, inquire again or even several times, "Anything else?" You may need to lead the patient back several times to additional concerns or issues he or she may want to tell you about.

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