Introduction

Reviews

Does Your Doctor Know How to Talk to You?

Timothy B. McCall, M.D.

Experts studying medical interviewing have discovered that doctors vary greatly in the methods they use to interview patients. Some are much more effective at eliciting important information and leave patients feeling listened to and more satisfied.

Some examples of poor interview technique include the following:

• The doctor interrupts you. There is an old saying, God gave you two ears and one mouth. Listen twice as much as you talk. Doctors would do well to heed the advice. Most of them don’t allow their patients to fully tell their stories. Researchers at Wayne State University in Detroit tape recorded office visits to analyze how doctors interviewed patients. They found that doctors typically interrupted patients within the first few seconds of the interview. The average time until the first interruption was 18 seconds. The doctors allowed their patients to finish their opening statement less than a quarter of the time. The researchers concluded that when doctors interrupt, they cut off the spontaneous flow of information and, in effect, deny many patient the opportunity to raise important concerns.
• The doctor asks mostly yes or no questions. Studies show that a string of yes or no questions is a poor way to conduct an interview. Important information may be missed. Doctors may jump to premature conclusions about the cause of the symptoms. Skillful interviewers, on the other hand, begin with open-ended questions like, "what's the matter?" or, "how can I help you?" and allow patients to tell their stories in their own words. As these doctors home in on a diagnosis, they may ask more pointed questions like Is there any relation between eating and the pain? and then even more specific questions like Did antacids help?
• The doctor asks leading questions. "Do you still beat your wife?" is the archetypal inappropriate leading question. Experts believe that less obviously inappropriate leading questions like, "the pain didn't wake you up at night, did it?" may lead to inaccurate answers.
• The doctor uses medical jargon. The problem with the fancy Latin and Greek terms doctors throw around is that their patients may not understand them. For most people, "have you noticed your heart pounding hard or fast or skipping beats?" is preferable to, "have you noticed any palpitations?"
• The doctor seems rushed or distracted. Although a busy doctor may have a lot on his or her mind, you should have the sense that while you’re together, you’ve got the doctor’s undivided attention. It’s best if the doctor isn’t flipping through your chart or taking extensive notes while you speak. If the doctor’s mind is elsewhere, the doctor may not hear what you say.

When you're evaluating a doctor's interview technique, remember, given time constraints, it isn't always possible for a physician to address every concern you might have. If you have more concerns than can reasonably be addressed in a single appointment, try to make an agreement with the doctor to deal with your most pressing problems first and, if necessary, schedule a return appointment to get to the others.

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