Interviewing Patients of Different Ages

As patients move through different stages of life, you will need to make certain adaptations in your interviewing style. This section provides suggestions for talking with children, adolescents, and the elderly.

Talking With Children. Unlike adults, children usually are accompanied by a parent or caregiver. Even when adolescents are alone, they are often seeking health care at the request of their parents—indeed, the parent is usually sitting in the waiting room. When interviewing a child, you need to consider the needs and perspectives of both the child and the caregivers. In addition, the dictates of "well child care" may preset the clinician's agenda toward immunizations, anticipatory guidance, or developmental assessment.

Establishing Rapport. Begin the interview by greeting and establishing rapport with each person present. Refer to the infant or child by name rather than by "him," "her," or "the baby." Clarify the role or relationship of all the adults and children. "Now, are you Jimmy's grandmother?" "Please help me by telling me Jimmy's relationship to everyone here." Address the parents as "Mr. Smith" and "Ms. Smith" rather than by their first names or "Mom" or "Dad." When the family structure is not immediately clear, you may avoid embarrassment by asking directly about other members. "Who else lives in the home?" "Who is Jimmy's father?" "Do you live together?" Do not assume that just because parents are separated that only one parent is actively involved in the child's life.

To establish rapport, the key is to meet children on their own level. Use your personal experiences with children to guide how you interact in a health care setting. Maintaining eye contact at their level (for example, sit on the floor if needed), participating in playful engagement, and talking about what interests them are always good strategies. Ask children about their clothes, one of their toys, what book or TV show they like, or their adult companion in an enthusiastic but gentle style. Spending time at the beginning of the interview to calm down and connect with an anxious child or crying infant can put both the child and the caregiver at ease.

Working With Families. One of the biggest challenges when several people are present is deciding to whom to direct your questions. While eventually you need to get information from both the child and the parent(s), it is useful to start with the child if he or she can talk. Even at age 3 years, some children can tell you about the specific problem. Asking simple open-ended questions such as "Are you sick? . . . Tell me about it." followed by more specific questions often provides much of the History of the Present Illness. The parents can then verify the information, add details that give you the larger context, and identify other issues you need to address. You need to characterize symptom attributes the same way you do with adults. Sometimes children are embarrassed to begin, but once the parent has started the conversation, you can direct the questions back to the child.

■ "Your mother tells me that you get a lot of stomachaches. Tell me about Q them."

■ "Show me where you get the pain. What does it feel like?"

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