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The patient interview: Learn to communicate

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As dental hygienists, interviews are a vital part of our responsibilities. Initial data about patients is usually collected through a questionnaire and followed by an interview. Through questions and answers we can learn about our patients’ experiences. Verification and accuracy of this information has a direct and legal impact on treatment. Test results support our inquiries, which are fairly straightforward and easily documented. However, when verbal and nonverbal language comes into play, it’s difficult to collect and assess data. English as a second language, different cultural and social backgrounds, and previous health-care experiences can influence communication.

The interview is many patients’ initial exposure to the office. It may also be the first time they meet a dental hygienist. The image conveyed sets the tone for the patient/practitioner relationship. As health-care providers, it is important to foster good clinician/patient relationships, which in turn support positive outcomes. Interviews allow both parties to evaluate each other’s knowledge, concerns, and competencies.

There are four types of interviews necessary for comprehensive patient treatment: information getting, information giving, persuasive, and counseling. These forms of communication, in which listening and speaking are equally important, differ from nonverbal questionnaires and help create a partnership and sharing of information that foster openness and trust between the patient and hygienist.

Information-getting interview - The purpose of this interview is to elicit information about the patient relating to treatment. Examples are medical, dental, and prevention histories. The data collected may include the patient’s opinions, knowledge, attitudes, behaviors, and insights that will guide, modify, terminate, or postpone treatment.

Information-giving interview - Dental professionals engage in this type of interview when they provide information to a patient. Explaining how to take medications or how to record signs and symptoms for later reporting are examples of an information interview.

Persuasive interview - The persuasive interview attempts to change an attitude or influence a behavior, a practice most often associated with salespeople. Dental hygienists need to be persuasive when they recommend care products such as power-driven toothbrushes or interdental cleaners, or when they promote a behavior change that is in the best interests of the patient.

Counseling interview - Similar to the persuasive interview, a counseling interview focuses on changing a behavior that may be based in a problem or compulsion that the patient wants to overcome. Tobacco cessation counseling is the most common therapy conducted by dental hygienists.

Interviewing structures

All interviews follow a basic structure. This establishes good communication where active listening by both the interviewer and interviewee is required and substantive matters are discussed. Understanding where you are throughout an interview allows you to modify your communication appropriately.

The opening stage of an interview is brief. Its purpose is to establish a comfortable environment. After greetings and introductions, successful communicators will explain the purpose of the interview, outline the discussion, and explain how they plan to accomplish the purpose.

Regarding information-getting interviews, patients may be aware of the procedure, but many will not know why the questions are being asked or what part they play in the discussion. Patients who understand the reasons and agenda for the interview can participate better.

An initial discussion allows the hygienist to assess past medical and dental experiences and educate the patient about the links between systemic disease and oral health. Data that reveals a patient’s cognitive knowledge, manual skills, health perceptions, and beliefs will greatly influence treatment strategies and counseling tactics. This information sharing establishes rapport and patient risk factors, and it empowers the patient. The patient’s full participation helps create a patient-centered treatment environment.

The second stage of the interview takes the most time because the purpose is to exchange information. Most practices use preprinted forms for the information-getting interview as well as for the information-giving and counseling interviews. If previous data is available, it should be studied before the appointment and reviewed with the patient. Communication during this phase tends to move from the broad to the refined. The hygienist may ask the patient to take the lead by asking questions or volunteering ideas that relate to the data.

The closing stage of the interview is brief. The hygienist summarizes what has been discussed and what will happen next, either at the present time or in the future. Summarizing the discussion helps ensure that there will be an accurate and complete record of the interview.

Interviewing styles vary. No matter what style is used, success is influenced by the communication climate and the balance of power between the participants. Openness, trust, rapport, and comfort play important roles in successful communication.

As professionals, dental hygienists bring a certain amount of formality to the interview. Patients expect hygienists to be knowledgeable, and to practice with the best interests of the patients in mind. Nonverbal cues such as professional dress, the interview setting, and formal use of last names and professional titles support a formal interviewing atmosphere. New patients may tend to follow more defined communication boundaries in keeping with their prior social or cultural health-care experiences.

Conversely, interviews may be informal and include nonverbal communication cues such as relaxed posture, informal dress, and engaging the patient on a more personal level. These may be conducted in a room not used for treatment, with both parties using first names.

If efficiency is the motivator within an interview, an authoritarian approach should be used. Here the hygienist controls the discussion by not deviating from a prescribed set of questions or topics. The patient is not encouraged to ask questions or initiate topics. Disadvantages of this style are that it may cause the hygienist to miss relevant information and may prove frustrating to the patient.

A more balanced approach, called a distributed interview, divides power equally between participants. Both ask questions, listen, speak, and add to the direction and content of the talk. Although this style is usually used between people with the same social or professional status, it fosters a sense of shared responsibility for the patient’s oral health.

A mirrored or reflective interview is one in which the hygienist restates or paraphrases what the patient says, or makes limited inferences about the patient’s comments. What the patient says becomes the basis for discussion. Focused and thoughtful listening skills are necessary for this style.

Unlike an informal chat, the interview follows a question and answer pattern that allows each person to speak briefly. To be effective, it is important for the hygienist to be comfortable with the questions necessary to elicit information and establish a positive relationship with the patient.

Open-ended questions are broad and initiate new topics. These types of questions cannot be answered with a simple yes or no, and allow patients to guide the conversation toward information they want to share. “How would you describe your oral health?” is an example.

In contrast, closed questions can be answered with yes or no and are used when a narrow answer is appropriate. “How many times a day do you brush?”

Probing questions are used to expand upon facts gathered. These are important when additional or insightful information is needed. “You mentioned that the new brushing method you use is difficult. Can you be more specific?”

A leading question is used to test a respondent’s commitment to an idea, but is not a good way to encourage a candid reply. Leading questions such as “You believe that brushing is important, don’t you?” are often answered with what patients think you want to hear. But a leading question such as, “After awhile the novelty of this electric brush will wear off, but you will continue to use it, right?” confirms a patient’s future performance.

“I believe that we have covered everything” is a summary question. Though it is in the form of a statement, it requires a response. This type of question summarizes the conversation and affords the hygienist and patient the opportunity to agree with what was said.

Hypothetical questions pose a scenario and ask the respondent to react. A question such as, “What will you do if you can’t find the floss you like while you’re on vacation?” will help the hygienist understand the patient’s reaction to a challenging treatment strategy.

The ability to optimally treat patients relies heavily upon our ability to successfully gather information while establishing our credibility as knowledgeable, caring oral health-care providers. Focused, thoughtful interviewing supports this effort and affords us the opportunity to establish productive partnerships with our patients.

References

• Coulehan JL, Block MR. The medical interview, mastering skills for clinical practice, Fourth Edition. Philadelphia, F.A. Davis Company, 2001.

• Cooper MD, Wiechmann L. Essentials of dental hygiene preclinical skills. Upper Saddle River, N.J., Pearson Preston Hall, 2004.

• Daniel SJ, Harst SA. Mosby’s dental hygiene concepts, cases, and competencies. St. Louis, Mosby, 2002.

• Wood JT. Communication mosaics: an introduction to the field of communication, Second Edition. Australia, Wadsworth/Thomson Learning, 2001.

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