■ Greeting the patient and establishing rapport
■ Inviting the patient's story
■ Establishing the agenda for the interview
■ Expanding and clarifying the patient's story; generating and testing diagnostic hypotheses
■ Creating a shared understanding of the problem(s)
■ Negotiating a plan (includes further evaluation, treatment, and patient education)
■ Planning for follow-up and closing the interview.
As a student, you will concentrate primarily on gathering the patient's story and creating a shared understanding of the problem. As you become a practicing clinician, negotiating a plan for further evaluation and treatment will become more important. Whether the interview is comprehensive or focused, you should move through this sequence while closely attending to the patient's feelings and affect.
Greeting the Patient and Establishing Rapport. The initial moments of your encounter with the patient lay the foundation for your ongoing relationship. How you greet the patient and other visitors in the room, provide for the patient's comfort, and arrange the physical setting all shape the patient's first impressions.
As you begin, greet the patient by name and introduce yourself, giving your own name. If possible, shake hands with the patient. If this is the first contact, explain your role, including your status as a student and how you will be involved in the patient's care. Repeat this part of the introduction on subsequent meetings until you are confident that the patient knows who you are. "Good morning, Mr. Peters. I'm Susan Jones, a 3rd-year medical student. You may remember me. I was here yesterday talking with you about your heart problems. I'm part of the medical team that's taking care of you."
Using a title to address the patient (e.g., Mr. O'Neil, Ms. Washington) is always best. Except with children or adolescents, avoid first names unless you have specific permission from the patient or family. Addressing an unfamiliar adult as "granny" or "dear" tends to depersonalize and demean. If you are unsure how to pronounce the patient's name, don't be afraid to ask. You can say "I'm afraid of mispronouncing your name. Could you say it for me?" Then repeat it to make sure that you heard it correctly.
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