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
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 narrative7. Identify interview errors and pitfalls
Objectives of the initial interview1. Establishing the professional relationship2. Obtaining information3. Understanding the total patient
Objectives of the interview1-Establishing the professional relationshipPositive 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
Objectives of the interview2-Obtaining informationInterview is different than casual conversationIn an interview one participant makes a conscious effort to obtain information from the otherA skilled interviewer can achieve this goal while making the subject feel engaged in pleasant conversation
Objectives of the interview3-Understanding the total patient No ideal treatment plan fits and is best for all patients The most expensive procedure or clinically difficult procedures couldnt 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
Basic interviewing skills andmodifying factors1. Considering the interview as a clinical procedure2. Initiating the interview3. Questionaire4. Taking notes5. Importance of minimal activity6. Changing topics7. Asking questions8. Basic question types
1-Considering the interview as aclinical 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
2-Initiating the interview1-often initiated by a gesture2-dentist should be aware of the basic reasonof the visit3- opening statement should depend on thereason of the visit Basic interviewing skills and modifying factors
3-QuestionnaireAdvantages 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
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
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
4-Taking notes Advantages Most people view note taking as a sign of interest and competence and expect itDisadvantages May be distracting Patients may be suspicious of it Basic interviewing skills and modifying factors
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
Asking questions There are three basic question types:1- Open ended question2- Closed question3-Leading question Basic interviewing skills and modifying factors
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 ?
Open ended questionCover broad subject area Ex :how do you feel? How are things? How do you feel teeth?
Open ended questionAdvantages: 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.
Close end question May require only yes or no answer Ex: Do you have heart problem? Do you smoke?
Closed questionsAdvantages: 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.
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.
Leading questionsLess desirable as it suggest a responseEx:Does the pain feel like an electric shock ?
ESSENTIAL PRINCIPLES Start with an open question. Mix open and closed questions. Avoid leading questions.
Assisting the patient’s narrativeSpecific interviewing techniques:1. Developing rapport2. Keeping your distance3. Facilitation4. Interpretation
1-Developing rapport Rapport is a state of mutual interest and respect that allows for direct and open communicationTo 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
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
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
4-Interpretation: By making conclusion or comments describe feelings or motives to patient’s narrative
Nonverbal communication Touch Body language Dress and personal hygiene silence
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)
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.
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 patients body language.
Dress and Personal Hygiene Dress and personal hygiene communicate something about how the patient would like others to relate to him or her.
Interviewing errors and pitfalls1. Suggestive Questions2. Why Questions3. Multiple Questions4. Questions answered by yes or no5. Patient’s Questions6. Hasty reassurance and early opinion7. Use of jargon8. Assuming patients’ understanding9. Use of emotionally neutral word
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
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
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
4-Questions Answered by Yes No It gives no details When obtained, one should ask follow-up and check questions. Interviewing errors and pitfalls
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
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
7-Use of JargonThe use of professional jargon leads to misunderstanding and confusion Interviewing errors and pitfalls
8-Assuming Patients UnderstandingDentist should ensure that the patient understand what is said specifically in relation to dentist’s instructions Interviewing errors and pitfalls
9-Use of Emotionally Neutral Words In choosing words, efforts should be directed toward keeping the patients environment pleasant by using phrases that are mild and do not conjure up undesirable images. Interviewing errors and pitfalls
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. Burketts Oral Medicine& Diagnoses, 11th ed., Philadelphia P.C Decker. Inc.2008 page 5