Medical interview is focus of communication skills workshop

By Mary Ann Porucznik

What is the one procedure that all orthopaedic surgeons will perform—usually more than 100,000 times throughout their careers? The medical interview.

During the medical interview, orthopaedists focus on diagnosing the patient’s problem (finding it) and developing a treatment regimen (fixing it). But according to Robert E. Eilert, MD, who will be conducting one of tomorrow’s Communication Skills Workshop, that’s only half the job of a medical interview.

Dr. Eilert and his co-instructor, Michele M. Zembo, MD, are both mentors for the AAOS Communications Skills Mentoring Program (CSMP). Using an educational model developed by the Institute for Healthcare Communications and updated with orthopaedic-specific video vignettes, they help attendees learn techniques that would improve their communication skills.

“This interactive workshop provides the resources, tools and answers that we can fit in our own day-to-day practice that are really important,” said Dr. Eilert. “It literally can transform the way you interact with patients.”

“This workshop is a lot of fun,” said Dr. Zembo. “It works equally well in teaching both residents and practicing orthopaedists about new communication techniques.”

Each workshop is limited to just 30 participants, which enables plenty of time for creative engagement. The four-hour workshops include video vignettes and role-playing as well as lively learning discussions and opportunities to apply specific techniques.

Meeting new patients

According to Dr. Eilert, research shows that you can avoid misunderstandings that might occur in the initial exam if you spend more time with the patient. “Spending more time with a patient might save you great aggravation,” he explained. “You will also be able to get a more accurate diagnosis if you get the patient’s story directly—rather than by asking closed-ended questions that can lead you down the wrong path.”

Workshop participants will have the opportunity to polish their “welcoming statements,” which should include both a greeting and an engaging, normalizing comment as well as a personal introduction.

Although Americans often greet each other with a simple “Hi, how are you?” physicians should avoid using this approach.

“It’s better to ask about the weather or the roads or the local sports team,” said Dr. Eilert. “You don’t want to put patients in the awkward position of telling you they’re ‘fine’ when you both know that the patient’s there because of an illness or injury.”

After greeting the patient, sit down, lean forward, maintain eye contact, smile, and ask, “How can I help you today?”

By taking a few minutes to build rapport with the patient, the physician is able to establish a “partnership” that increases the likelihood of a successful outcome. Using open-ended questions such as “I’m curious about…” encourages the patient to tell his or her story and reinforces the patient’s perception of the physician as a caring individual.

More positive outcomes

The effects of good communication can be seen both in health and in social outcomes. Patient satisfaction, based on comfort levels and a feeling that “my doctor understands,” is a major factor in reducing a physician’s medical liability risk. In one study, more than 70 percent of claimants cited a poor relationship with their physician as one reason for filing the claim.

At the close of the interview, enlistment techniques invite the patient’s collaboration in decision-making and treatment programs. According to one study, for example, of 750 million prescriptions written each year, nearly one-third are never filled, and another third are not taken as prescribed. An AARP survey showed that the primary reason prescriptions are not filled is the patient’s concern about side effects.

To convince a patient to adhere to a treatment regimen, physicians must keep the regimen simple, tailor it to the patient’s habits and routine, and identify and remove obstacles, such as the patient’s concern about side effects. In these situations, the physician needs to educate the patient about the seriousness of the condition and the efficacy of the treatment, as well as prepare for problems such as missed dosages or side effects.

A four-part close

An often-overlooked part of the interview is the close. The close has four parts: a signal that the interview is ending; a summary of the diagnosis, treatment and prognosis; a review of next steps; and an expression of hope in leave-taking.

For more information about the CSM program and a list of upcoming workshops, visit the AAOS Web site, click on Medical Education and scroll down to the Communications Skills Mentoring Program.

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