The lecture presents skills and requirements of the initial interview in dental clinic, how could dentist gain patient rapport and patient's required information to reach diagnosis also identifying pits and errors of initial interview

1. Introduction to clinical
experience course
1- Initial interview
Dr Maha Mahmoud
Associate professor of Oral Medicine

3. Third year second term course
Faculty of Dentistry Umm Al-Qura University

4. GOLDEN RULE
Attendance
References
Assessment

6. Objectives:
1. Define the objectives of initial interview .
2. Identify the basic interview skills.
3. Learn how to develop patient rapport.
4. Differentiate between types of questions used for the
interview.
5. Learn how to ask questions to gain information
necessary for diagnosis.
6. Learn how to assist the patient narrative
7. Identify interview errors and pitfalls

7. Objectives of the initial interview
1. Establishing the professional relationship
2. Obtaining information
3. Understanding the total patient

8. Objectives of the interview
1-Establishing the professional relationship
Positive interview Cause the patient to be more receptive
to:
 the dentist’s professional judgment
 the dentist’s treatment recommendations.
 Any advice or instructions( better understood,
accepted and followed).
 It Help Development of professional competence

9. Objectives of the interview
2-Obtaining information
Interview is different than casual conversation
In an interview one participant makes a conscious
effort to obtain information from the other
A skilled interviewer can achieve this goal while
making the subject feel engaged in pleasant
conversation

10. Objectives of the interview
3-Understanding the total patient
 No ideal treatment plan fits and is best for all patients
 The most expensive procedure or clinically difficult
procedures couldn't be the best for all patients.
 Factors other than the condition of teeth and supporting
structures should be considered that include:
Patient’s desires
Patient capabilities
Systemic health
Occupation
Availability for treatment

12. Basic interviewing skills and
modifying factors
1. Considering the interview as a clinical procedure
2. Initiating the interview
3. Questionaire
4. Taking notes
5. Importance of minimal activity
6. Changing topics
7. Asking questions
8. Basic question types

13. 1-Considering the interview as a
clinical procedure
• Adequate time for the interview must be
scheduled.
• In many cases it produces information more
than the examination itself.
• In modern practice, it is considered
invaluable in the management of patient
with problems that can’t be easily
understood as TMJ disorders
Xerostomia, chronic pain,…..)
Basic interviewing skills and modifying factors

14. 2-Initiating the interview
1-often initiated by a gesture
2-dentist should be aware of the basic reason
of the visit
3- opening statement should depend on the
reason of the visit
Basic interviewing skills and modifying factors

15. 3-Questionnaire
Advantages Disadvantages
 Easy to administer  Restricted to certain chosen
 Do not require significant questions.
chair side time.  Can be misunderstood by
 Gives starting point to begin patient.
with.  Cover broad area without
focusing .
Basic interviewing skills and modifying factors

16. Interview
 Fostering good patient-provider relationship
 Provides an opportunity for patient education and
discussion.
 Interview allows dentist to observe and evaluate
patient response.
 Help to build rapport necessary for effective
professional relations.
 Encourage patient to provide greater detail about
selected symptoms.
Basic interviewing skills and modifying factors

17. 3-Questionnaire
 Questionnaire is good point
to start with.
 Allows dentist to make
certain observations
concerning patient responses.
 Medical questionnaire is
useful but not a substitute for
the interview.
Basic interviewing skills and modifying factors

18. 4-Taking notes
Advantages
 Most people view note taking
as a sign of interest and
competence and expect it
Disadvantages
 May be distracting
 Patients may be suspicious of it
Basic interviewing skills and modifying factors

19. Tips helping interview
 The less one says and does the more the patient may talk
 Direct questioning may be required with less
communicative individuals
 Distraction activity should be avoided
 Generally the interview should flow without interruption.
 For changing topic, wait for a pause or watch for a natural
bridge or explain straight forwardly that it is necessary to
change topic and why.
 Basic rule in interview and clinical practice to
Inform before you perform

20. Asking questions
 There are three basic question types:
1- Open ended question
2- Closed question
3-Leading question
Basic interviewing skills and modifying factors

21. Question types
Type of question Example
Tell me about the pain .
Open
Close What does the pain feel like
.
Does the pain feel like an
Leading electric shock ?

22. Open ended question
Cover broad subject area
 Ex :how do you feel?
 How are things?
 How do you feel teeth?

23. Open ended question
Advantages:
 Allow patients to use their own words and summarize
their view of the problem.
 Allow patients to partly direct the history taking, gives
them confidence and quickly generates rapport.
Disadvantages:
 Clinicians must listen carefully and avoid interruptions
to extract the relevant information.
 Patients tend to decide what information is relevant.

24. Close end question
 May require only yes or no answer
Ex:
 Do you have heart problem?
 Do you smoke?

25. Closed questions
Advantages:
 Elicits specific information quickly .
 Useful to fill gaps in the information given in response
to open question .
 Prevents vague patients from rambling away from the
complaint.

26. Closed question
 Disadvantages:
 Patients may infer that the clinician is not really
interested in their problem.
 Important information may be lost if not specially
requested.
 Restricts the patients opportunities to talk.

27. Leading questions
Less desirable as it suggest a response
Ex:
Does the pain feel like an electric shock ?

28. ESSENTIAL PRINCIPLES
 Start with an open question.
 Mix open and closed questions.
 Avoid leading questions.

29. Assisting the patient’s narrative
Specific interviewing techniques:
1. Developing rapport
2. Keeping your distance
3. Facilitation
4. Interpretation

30. 1-Developing rapport
 Rapport is a state of mutual interest and respect that
allows for direct and open communication
To develop it dentist should be
 Supportive by showing interest and concern
 Should be reassuring and show empathy
 Patient’s feeling should be respected
 Should not criticize patient in any way
Assisting the patient’s narrative

31. 2-Keeping your distance
 It should be done in the dental operatory
 Dentist and patient should be seated upright and in
full view of one another
 Should not take place in an area where other patients
are present
 Should be conducted by the dentist himself not by an
ancillary personnel
Assisting the patient’s narrative

32. 3-Facilitation:
 It is a verbal or nonverbal gesture made to encourage
the patient to continue talking
 It may be a phrase worded to help patient’s flow of
thought.
Assisting the patient’s narrative

33. 4-Interpretation:
 By making conclusion or comments describe feelings
or motives to patient’s narrative

34. Nonverbal communication
 Touch
 Body language
 Dress and personal hygiene
 silence

35. Touch
The value of this activity varies and depends upon:
 How the contact is made
 The sex of the individuals
 The age differential
 The timing of the action
( A reassuring hand on the shoulder is
better premedication than 100 mg
barbiturate)

36. Body Language
 Individual moods such as sadness, anxiety, happiness,
and others are more properly called affectual states.
 Bode language in the form of gestures and posture
often indicates these affectures states.

37. Body Language
 Depression can be produced by life
circumstances, physical ailments, and drugs.
 A depressed patient may be difficult to manage, and
conversion of the depression into dental symptoms may
occur.
 Anger and hostility are reactions to sickness in some
people, and the dentist may become the target of these
feelings.
 Anxiety is an unpleasant affectual state that may be caused
by a real or an imagined threat.
Sometimes receptivity to new ideas can be judged by the
patient's body language.

38. Dress and Personal Hygiene
 Dress and personal hygiene communicate something
about how the patient would like others to relate to
him or her.

39. Interviewing errors and pitfalls
1. Suggestive Questions
2. Why Questions
3. Multiple Questions
4. Questions answered by yes or no
5. Patient’s Questions
6. Hasty reassurance and early opinion
7. Use of jargon
8. Assuming patients’ understanding
9. Use of emotionally neutral word

40. 1-Suggestive Questions
 Gives the answer in the phrasing of the question.
 May not suggest an exact answer but could narrow the
field of answer.
Interviewing errors and pitfalls

41. 2-"Why" Questions
 Generally it shouldn’t be asked by the interviewer
Ex:
 why don’t you brush your teeth?
 When asked the patient feels threatened
Interviewing errors and pitfalls

42. 3-Multiple Questions
 Multiple rapidly fired questions are rarely helpful
Exception:
 With uncommunicative people, they help them to
begin answering
 Ex: when did the pain begin?, what makes pain relief?,
does anything make it worse?
 Disadvantage: they may be confusing
Interviewing errors and pitfalls

43. 4-Questions Answered by Yes No
 It gives no details
 When obtained, one should ask follow-up and check
questions.
Interviewing errors and pitfalls

44. 5-Patients' Questions
 Generally the dentist does not have adequate
information to answer questions on the future care of
the patient during the interview
 Should be at the appropriate time
 Personal questions should be answered only if they
will not harm the professional relationship.
 It may be a signal that the patient wishes to change the
topic
Interviewing errors and pitfalls

45. 6-Hasty Reassurance and Early Opinions
 Rapid and early response should be avoided until
everything has been gathered and a diagnosis has been
made.
 Dentist should give note that opinion will be given at
the earliest appropriate time
Interviewing errors and pitfalls

46. 7-Use of Jargon
The use of professional jargon leads to
misunderstanding and confusion
Interviewing errors and pitfalls

47. 8-Assuming Patients' Understanding
Dentist should ensure that the patient understand what
is said specifically in relation to dentist’s instructions
Interviewing errors and pitfalls

48. 9-Use of Emotionally Neutral Words
In choosing words, efforts should be directed toward
keeping the patient's environment pleasant by using
phrases that are mild and do not conjure up
undesirable images.
Interviewing errors and pitfalls

49. References
 Steven L. Bricker, Robert P. Langlais, Craig S. Miller.
Oral Diagnosis, Oral Medicine, and Treatment
Planning, second edition, BC Decker Inc.2002
 Greenberg MS, Glick M. Burkett's Oral Medicine&
Diagnoses, 11th ed., Philadelphia P.C Decker.
Inc.2008 page 5