الجامعة السورية الخاصة كلية الطب البشري قسم الجراحة

1. الجامعة السورية الخاصة كلية الطب البشريقسم الجراحة M.A.Kubtan Interviewing Technique أ.د.عاصم قبطان MD-FRCS

2. The purpose of the paradigm is to provide a structural mnemonic that moves the conversation logically and holistically throughout the interview Any particular part of the interview may be expanded as the situation warrants, and any part may be minimized. M.A.Kubtan

3. The art of interviewing • Listening is a key element for any successful interview. • Building bridges of understanding helps to manage the various difficulties of the interview. • Being sensitive to various forms of diversity, including disabilities, religious issues, and ethnicity, will enhance communication and participation by the patient. M.A.Kubtan

4. Interviewing Techniques Very important to enhance communication and participation by the patient . Skill developed only through experience . Three Rs : • Rapport • Respect • Relationship The quality of the relationship between the physician and patient is it self therapeutic . M.A.Kubtan

5. Michael Lambert,s Study 2009 30% of any therapeutic changes is based on the quality of the relationship between the physician and the patient . Based on : • Listening . • Mutual respect . • Empathy ( التعاطف مع المريض ) . • Patients acceptance Physician should take time to listen and understand the patients concerns M.A.Kubtan

6. Ways of Approaching the Patient • Interviewing first in the office then examining the patient in the examination room . • Interviewing the patient while on the examining couch . M.A.Kubtan

7. In the Examination Setting The multi sensory process • The physician listen to what is spoken . • Listen with the eyes watching for non verbal behaviors . • Listen with the fingers as examination completed . • Patient must be convinced that the physician not in hurry . M.A.Kubtan

8. Principals of Interview • The content : is the subject matter of the interview . • The process : is rapport, or how the interview flows as the content is discussed. M.A.Kubtan

9. LISTEN Paradigm for Interviewing and Assessment L: Active listening, verbal and nonverbal, eyes and ears, respectful, affirming . I: Interpersonal interaction, mutuality, natural pacing, familial and social . S: Somatic, sensory, sense, sensitivity, body, behavior, healthy and unhealthy, reality, making sense, context . T: Thinking, cognition( معرفة ) , intelligence, problem solving, daily living, self-care . E: Emotion, affect, expressiveness, congruence ( انسجام ) and consistency . N: Normal, now, present, resources, positive person strengths, cooperation in the healing process . M.A.Kubtan

10. Effective Communication Barriers • Walk-in patients • Insufficient length of time • Hidden agendas of the patient • Time for dictation and documentation M.A.Kubtan

11. M.A.Kubtan Bridges Adequate same-day appointment Improved triage on the phone Ask patients to bring a problem list with them Consider dictating or documenting while still in the room with the patient.

12. M.A.Kubtan Interruptions Phone calls Knocks on the door

13. Complementary and Alternative Medicine Barriers • Negative or cynical attitude of the physician • Patient fears or indifference toward informing the physician about their use of CAM. • Lack of knowledge about the CAM practices. M.A.Kubtan

14. M.A.Kubtan Bridges Approach questions regarding CAM with an open and respectful tone, similar to taking a sexual history or inquiring about alcohol and tobacco use. Use a preprinted form or routinely ask patients to list all dietary supplements they take .

15. General Interview Advices • Be cautious when accepting the flattery of patients who are critical of the care they received from other physicians these patients may have a long history of failed patient-physician relationships caused by unreasonable expectations. • Avoid being “inserted” into the middle of a family conflict . • It is a wise general policy to avoid criticism of other health providers . • Criticism of office or hospital staff behavior in the presence of the patient is inappropriate and may be damaging to the patient-physician or hospital relationship. M.A.Kubtan

16. Age Considerations for the Interview • Infants and Babies • Toddlers and Children • Adolescents • Adult Patients • Elderly Patients • Demented Elderly Patients • The Difficult Patient • The Somatizing Patient M.A.Kubtan

17. Giving Bad NewsThe ABCDE technique • Advanced preparation. Be familiar with relevant clinical information . • Build a therapeutic environment and relationship. Have family support present . • Communicate well. • Deal with reactions. • Encourage and validate. Explore what the news means to the patient. Offer realistic hope. M.A.Kubtan

18. Clinical Examination As the physician examines the patient, each action is preceded by an explanation of what the patient can expect to happen next. The physical environment of the room should be welcoming and inviting, creating a sense of comfort to the patient. M.A.Kubtan

19. M.A.Kubtan Biopsychosocial understanding of the patient., Good clinician communication does prevent malpractice suits القضاء . The patient wants to tell a story, to help better understand the illness, as well as find healing and recovery. A patient who feels that the clinician listens to and understands him or her is not likely to sue that person, even if there is a bad outcome .