The three question interview


I make the patient’s eyes glisten,

When I just quietly listen.

            I use questions three

            And eye contact, you see,

I avoid interruptions and dissin’.

 

My approach to interviewing patients changed radically about 15 years ago.  I start with “Tell me about your (problem).”  I wait till the patient stops talking, then I say, “Tell me more.”  When the patient stops talking I say, “What else?”  With the electronic medical record and a good set of software abbreviations I can keyboard 80% of what the patient says word for word.  Before I start asking directed questions, the patient has given me the vast majority of the history and has gotten the impression that I’m a good listener (which I am), mostly because I don’t interrupt.

Even if the patient’s narrative wanders I keep listening while the patient tells me what is on their mind.

I make exceptions to the rule of not interrupting.  I’ll interrupt an item by item account of a meal.  If the patient has given me an account of problems in 3 different systems before I can get the first sentence down, I’ll ask the patient to try to slow down and focus. 

If the patient has ADHD, I’ll ask straight out if their problem is acting up.

Which happened today.  The patient had a child and a sibling with ADHD, and the conversation drifted off topic between a sentence’s beginning and the end.  Such circumstances make a discussion difficult but not impossible, and by consistently asking the patient to redirect we could go over lab work and discuss therapeutic alternatives.

Another of today’s patients came in a wheelchair.  Our association goes back 18 years.  I cared for the patient and spouse during that time, watching the spouse’s increasing debility and finally the terminal illness.  I also cared for the patient after a surgery gone bad with chronic, unrelenting pain in the aftermath, and decreasing mobility from Parkinson’s.  Today, probably the last time we’ll meet, we discussed the fact that we made it three years past when the patient figured to die.

A third, wondering what to do after I take off, expressed the desire to see the doctor at the VA here in town.  I encouraged the decision, naming the doctor I go to.

I saw an unusual number of young people today between the ages of 14 and 20.  For some our relationship started with their mother’s positive pregnancy test and continued through the pregnancy, delivery, well child checks, and school physicals.  Some have joined the work force; one had a work-related injury, and balked at reporting it to the employer.  One came for a sports physical.  Two were in with coughs, one had an enlarging spleen which  warrants further investigation.

I love the breadth of human experience that comes with Family Practice, the depth of understanding unique to being privy to the secrets of real lives over decades.

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