Chapter 1
Patient Interviewing
4
, Chapter 1: Patient Interviewing
Types of interview
Initial history and mental state examination
o A large proportion of the task will be to find out facts. This does not mean that you should just enquire about
dates and events in a person’s life.
o You will also want to know the emotional significance of certain events for a patient.
o At the end of the interview, you should be able to make a differential diagnosis.
o It is important from the beginning to consider the extent to which you will need to promote compliance.
To make the correct diagnosis is usually insufficient if your patient does not return to the follow-up interview or
does not comply with the appropriate treatment.
Follow-up interview
o The purpose of these interviews varies enormously.
In a follow-up interview you may want to clarify certain areas that you did not get around to asking
about, or only briefly touched upon, in the first interview, in order to obtain further diagnostic
information.
You may want to initiate treatment or to monitor a patient’s mental state in order to assess their response
to treatment.
You may want to check whether a patient has any difficulties in following a treatment programme
and whether they have understood your explanation for their symptoms.
You may want to give the patient the chance to ventilate their feelings about a problem.
o It is always important to have an agenda (no matter how small) in your mind when you see a patient.
Otherwise, you are just conducting an unfocussed chat.
Ground rules
The setting of the interview
o Try to see patients in a quiet room where you will not be disturbed and where confidentiality can be
maintained.
o Try not to see patients in a busy dormitory on the ward.
o Interruptions by ringing telephones or people coming into the room are not conducive to creating an
atmosphere in which patients can talk openly about themselves.
Seating arrangements
o It is best to talk to a patient when both you and the patient are sitting on chairs of roughly the same height. If
you sit on a chair much higher than the patient, they can feel you are looking down on them. Conversely,
if you give them a higher chair, you may feel exposed and uncomfortable.
o Chairs are best arranged at a 120-130° angle to each other. This gives patients the chance to make eye
contact or to avoid it, whichever they feel most comfortable with.
o If you sit directly opposite the patient, they may feel stared at.
Note taking
o Avoid making detailed notes during an interview with a patient because it can be distracting for the patient
and may promote suspicion about what you are writing.
o Look at the patient when you ask a new question.
o Acknowledge that you have taken in their answers by looking at them. Otherwise, they may get the
impression that you are more interested in your notes than in them.
Duration of interview
o An hour and a half is about the maximum duration for an interview. After that, your concentration and that
of the patient will diminish.
o Some patients find interviews of 10-15 minutes too much. This may be because they are distractible,
tired, distressed or angry, or because they are avoiding you for a different reason.
o You will have to use your judgement whether to persevere a little with the interview or to go back to the
patient at another time.
Beginning an interview
o If it is the first time that you are meeting a patient, introduce yourself by name and explain what your role
is within the team.
o Tell the patient what the purpose of the interview is, what will happen to the information they give you, who
you will share it with and roughly how much time you intend to spend with them.
The middle part of the interview
o This is the main part of the interview during which you should be able to address the issues you want to
talk about.
Ending an interview
o Give patients some warning about the ending of an interview, e.g. “we have about another five minutes to
talk”.
o Do not leave questions that are potentially upsetting to a patient, to the end of an interview.
o Give patients some time to ask you questions (e.g. about their diagnosis or treatment, etc).
o Some patients will try to make you carry on talking to them beyond the agreed time by telling you something
5
Patient Interviewing
4
, Chapter 1: Patient Interviewing
Types of interview
Initial history and mental state examination
o A large proportion of the task will be to find out facts. This does not mean that you should just enquire about
dates and events in a person’s life.
o You will also want to know the emotional significance of certain events for a patient.
o At the end of the interview, you should be able to make a differential diagnosis.
o It is important from the beginning to consider the extent to which you will need to promote compliance.
To make the correct diagnosis is usually insufficient if your patient does not return to the follow-up interview or
does not comply with the appropriate treatment.
Follow-up interview
o The purpose of these interviews varies enormously.
In a follow-up interview you may want to clarify certain areas that you did not get around to asking
about, or only briefly touched upon, in the first interview, in order to obtain further diagnostic
information.
You may want to initiate treatment or to monitor a patient’s mental state in order to assess their response
to treatment.
You may want to check whether a patient has any difficulties in following a treatment programme
and whether they have understood your explanation for their symptoms.
You may want to give the patient the chance to ventilate their feelings about a problem.
o It is always important to have an agenda (no matter how small) in your mind when you see a patient.
Otherwise, you are just conducting an unfocussed chat.
Ground rules
The setting of the interview
o Try to see patients in a quiet room where you will not be disturbed and where confidentiality can be
maintained.
o Try not to see patients in a busy dormitory on the ward.
o Interruptions by ringing telephones or people coming into the room are not conducive to creating an
atmosphere in which patients can talk openly about themselves.
Seating arrangements
o It is best to talk to a patient when both you and the patient are sitting on chairs of roughly the same height. If
you sit on a chair much higher than the patient, they can feel you are looking down on them. Conversely,
if you give them a higher chair, you may feel exposed and uncomfortable.
o Chairs are best arranged at a 120-130° angle to each other. This gives patients the chance to make eye
contact or to avoid it, whichever they feel most comfortable with.
o If you sit directly opposite the patient, they may feel stared at.
Note taking
o Avoid making detailed notes during an interview with a patient because it can be distracting for the patient
and may promote suspicion about what you are writing.
o Look at the patient when you ask a new question.
o Acknowledge that you have taken in their answers by looking at them. Otherwise, they may get the
impression that you are more interested in your notes than in them.
Duration of interview
o An hour and a half is about the maximum duration for an interview. After that, your concentration and that
of the patient will diminish.
o Some patients find interviews of 10-15 minutes too much. This may be because they are distractible,
tired, distressed or angry, or because they are avoiding you for a different reason.
o You will have to use your judgement whether to persevere a little with the interview or to go back to the
patient at another time.
Beginning an interview
o If it is the first time that you are meeting a patient, introduce yourself by name and explain what your role
is within the team.
o Tell the patient what the purpose of the interview is, what will happen to the information they give you, who
you will share it with and roughly how much time you intend to spend with them.
The middle part of the interview
o This is the main part of the interview during which you should be able to address the issues you want to
talk about.
Ending an interview
o Give patients some warning about the ending of an interview, e.g. “we have about another five minutes to
talk”.
o Do not leave questions that are potentially upsetting to a patient, to the end of an interview.
o Give patients some time to ask you questions (e.g. about their diagnosis or treatment, etc).
o Some patients will try to make you carry on talking to them beyond the agreed time by telling you something
5
