Interviewing and Questioning Patients - Term Paper Example

Descriptive and analytical assignment Name: Institution: Date: Interviewing and Questioning Patients Introduction Interview in the medical field has gained recognition for the past two decades because researchers have acknowledged better understanding of relationship involving health and communication (Dart, 2011). Communication in health care particularly patient-centered communication has a great impact on health care delivery (Potter & Perry, 2009). A medical interview is regarded most resourceful tool for therapeutic and diagnostic purpose. On the other hand, interviewing appears to be the most complicated clinical ability to be mastered. The demands put on the medical practitioner are both emotional and intellectual. The analytical abilities of diagnostic reasoning need to be blended with the interpersonal abilities required to bring about connection with the client and facilitate communication. This paper will therefore discuss and analyze the theories related to interviewing and questioning patients particularly motivational interviewing and narrative theory. Recommendations are also provided to improve the examples in the context. Motivational Interviewing Theory It is apparent that approaches which are patient-centered in consultations of health care have excellent results compared to the conventional advice giving, particularly when there is involvement of lifestyle change. This is why the theory of Motivational Interviewing (MI) is very imperative because it is basically patient-centered. Motivational interview is a designed intervention for encouraging patients. MI offers a means through which health care providers work with clients who might not appear ready to implement behavior changes which are basically viewed as essentials by the health care expert (Dart, 2011). MI is a style of communication that executes unique methods and strategies like listening that is reflective; decision making that is mutual, and bringing out change talk (Dart, 2011). One is considered an MI practitioner that is effective when they have the capacity to purposefully make balance of the need to distress the comfortable and comfort the distressed, in order to make balance of the empathy expression with the need to create enough discrepancy to trigger change. One of the goals of MI is to help people to manage their resistance or ambivalences regarding change of behavior. MI seems to be specifically effective for people who appear to be resistant to change initially. On the other hand, with people who are highly motivated, MI might be counterproductive. MI tone is considered to be encouraging and nonjudgmental. Medical practitioners establish a climate that is supportive and non-confrontational whereby patients feel relaxed expressing both negative and positive features of their present behavior. Example of the problem In MI which is patient-centered, the patient should be encouraged to comfortably talk about how their typical day was in a framework that is non-pathological (Britt, Hudson & Blampied, 2004). However, there are circumstances in which health care practitioners do not provide enough time for clients to give their stories because they do not consider the needs of the patient needs first. An example is when a medical practitioner took too long to respond or ask the next question as he was taking too much time to write down the response of the patient from the beginning of the interview. Analysis of the problem The example is not patient centeredness because so much time was spent in writing down the responses of the patient instead of getting involved with the account of the patient where a rapport can be developed. Patient centeredness, which the health practitioner did not consider in his interview, implies that providers of health care are taking into consideration the desire of the patient for information and decision making that is shared. In the clinical consultation, care that is patient centered involves the communication between the patient and the health practitioner. It implies the behavioral skills of the practitioner to adapt and care for particular circumstances and needs of every individual, meaning, to adapt care to act in response of the patient, and not the patient to the care (Britt, Hudson & Blampied, 2004). Patient centered interviewing encourages health practitioners to reflect upon methods of incorporating perceptions of the patient into consultations. It entails looking for and accepting the ideas of the patient, giving acknowledgement and encouragement in order to respond to the perspective of the patient as an individual. Recommendations With reference to the example, some suggestions could be considered for future improvement. Research has shown that it can be tricky to execute care that is patient centered when health practitioners have a low morale and they are over worked (Britt, Hudson & Blampied, 2004). A number of health practitioners may not consider patient centered care as a prompt priority because the results are less evidently connected with immediate gain of health. This is why I recommend training of the practice of patient centeredness in clinical setting because a couple of health care givers feel somehow uncomfortable when they have insufficient training and skills to respond to patients. It is claimed that time is a factor in the clinical setting due to patients’ flow in the hospital thus inadequate time to acquire more information from the person. On the other hand, it is evidenced that interviews that are patient centered do not require too much time compared to general consultation (Dart, 2011). I also suggest that various communication styles like MI should be encouraged in hospital settings so that health practitioners are able to conduct medical interviews with ease. Narrative theory with regards to questioning Narrative theory which is also a therapy is considered a method that has substantial potential for giving clinicians extra tools that help them to handle various health practitioner-patient encounters that are difficult (Terry, 2010). The therapy of narrative is a psychotherapy form that highlights the significance of language and story within the building up and expression of intrapersonal and interpersonal issues. This approach uses questioning that is therapeutic to assist patients identify and consider the discrepant but constructive features of their present stories that are problem-saturated and to give them power to restructure a more desired direction of life. Questioning is seen as the fundamental narrative therapy tool. Health care practitioners use questions so as to recognize the main complaint, explain relevant symptomatology, obtain the present history of the illness, and design a differential finding (Shapiro, 2002). This form of questioning looks for particular answers and brings about information necessary for supporting or adjusting conclusions of the health practitioner. The questioning format appears to privilege the knowledge of the clinician over that of the client, by assuming that the client can either provide responses that are wrong or correct, valid or divergent data. The intent of narrative questioning is to uncover meaning and producing experience instead of creation of information (Terry, 2010). This questioning form highlights that clients make their own events interpretations and structure their own thoughts. The outcome is a course in which understanding and self-discovery of the patient are important, and the role of the health practitioner is facilitator and supporter. Example of the problem Health practitioners need to have an effective way of framing their questions. This will assist them to successfully obtain the necessary information from their clients. However, when this factor is not considered, health care practitioners often find them themselves in a disagreement with their clients simply because the desired answers are not obtained. For example, at the 16th second of the interview, when the patient was asked what he does during his free time, his response was no and the medical practitioner sarcastically told the patient that he does not have free time at all. Analysis of the problem This example demonstrates poor skills of phrasing questions. Effective questioning call for proper structuring of questions whereby one uses questions that are open-ended (Shapiro, 2002). Questions that are open-ended have the benefit of facilitating the health care practitioner to draw the patient into discussion thus obtaining the right information about what the client does during his free time. Posing divergent questions is also important because it helps bring about several possible answers that are relevant. Use of probing questions is advantageous as well because it draws the attention the patient hence a discussion environment is created and information about lifestyle could be obtained. Recommendations In accordance with the example, where there is poor questioning, a number of suggestions can be highlighted so as to improve this situation in the future. First, communication is the chief factor between health practitioner and the patient. Since a narrative method provides an effective means of communication between the health care provider and the client, it is then seen as the best approach for questioning. In the narrative method, the stress involving the health care practitioner and the client is on providing space for several viewpoints to come up and coexist, building horizontal mutual relationships, optimism, and openness (Terry, 2010). This is why I think narrative therapy should be encouraged in medical interviews because the medical professional can build a relationship not only with the disease of the client but with the life of the patient in a manner that surprise and entertain. Secondly, mastering the effective ways of questioning like the use of open-ended questions is very important because it gives room for discussion thereby the health practitioner know his or her patient well regardless of insufficient time (Potter & Perry, 2009). Conclusion This paper has presented an outlook of medical interview and questioning. It has discussed how medical interview is not a simple thing to do regardless of it being a necessity in the clinical setting. However, when some elements and theories are put into consideration, medical interviews can be as easy as counting one, two, and three. This is seen in the example provided whereby the medical practitioner spends a lot of writing down the responses of the patient instead of being connected with the patient whereby the patient is given enough time to talk about their problems like in the case of motivational interviewing where the interview is patient-centered. Another example illustrates poor skills of communication particularly in questioning where the question is not open ended thus restricting one from getting the desired information. Recommendations include effective training and use of communication skills as well as questioning skills through MI and narrative therapy. All in all, medical practitioners need to have positive attitude and practice good communication skills when dealing with patients so as to enhance better delivery of health care. References Shapiro, J. & Ross, V. (2002). Applications of Narrative Theory and Therapy to the Practice of Family Medicine. Fam Med. Vol. 34, Issue 2, pp 96-100. Britt, E., Hudson, S. & Blampied, N. (2004). Motivational interviewing in health settings: a review. Patient Education and Counseling. Vol. 53, pp 147-155. Terry, M. (2010). The Impact of Patient-Centered Narrative Interviewing on the Perceptions of Primary Care Clinicians: a Pilot Evaluation. Doctor of Nursing Practice (DNP) Projects. Paper 6. Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing. St. Louis, Mo: Mosby Elsevier. Dart, M. A. (2011). Motivational interviewing in nursing practice: Empowering the patient. Sudbury, Mass: Jones and Bartlett Publishers. Read More