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What we observe is not nature itself, but nature exposed to our method of questioning.

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Werner Heisenberg, 1958

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In Chapter 1, we introduced two types of interviewing skills: “patient-centered skills” and “clinician-centered skills.” Patient-centered interviewing skills are used at the beginning of the interaction to gather unique symptom and personal information from the patient; they are also used throughout the interview to build and maintain the clinician-patient relationship. By focusing on what the patient has already introduced, patient-centered skills encourage the patient's lead. A useful analogy is to view each individual bit of new information, from interviewer or patient, as being placed on a table between them. When using patient-centered interviewing skills all new bits of information are placed on the table by the patient. To be certain, clinicians will influence and have an effect upon the conversation by asking the patient to say more about a bit of information on the table, for example, but a patient-centered approach minimizes the clinician's impact. Clinician-centered interviewing skills are used in the middle of the interview to fill in the details of the patient's story, and to collect required routine data. Used prematurely, or excessively, clinician-centered skills can contaminate the patient's story with what is on the clinician's mind. This is sometimes referred to as premature hypothesis testing, which can lead to an inaccurate or biased view of the problem(s) and how best to deal with them.

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In this chapter, we focus on the specific data-gathering and relationship-building skills that are the interviewer's tools on a moment-to-moment basis (see Figure 2-1). These skills are patient-centered when they are used to facilitate the patient's telling her or his story with minimal interference from the interviewer's thoughts and ideas. They are clinician-centered when used to focus on a topic not yet introduced by the patient. For example, when “health” or “wife” have not been mentioned or alluded to by the patient, it would not be patient-centered to say, “Tell me about your health” (an open-ended request) or “What are your feelings about your wife” (direct emotion seeking). Clinician-centered inquiry that introduces new information is appropriate during the middle portion of the interview where one frequently must introduce ideas and concepts not yet mentioned by the patient—using open-ended skills (frequently), emotion-seeking skills (occasionally), and, primarily, closed-ended skills.

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Figure 2-1.
Graphic Jump Location

Dynamic Use of Facilitating Skills.

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Open-Ended Skills

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Open-ended skills are used to encourage the patient to freely express what is on her or his mind. There are two types of open-ended skills: (1) nonfocusing open-ended skills (silence, nonverbal encouragement, and neutral utterances) and (2) focusing open-ended skills (echoing, open-ended requests, summary). Nonfocusing skills are used throughout the interview to encourage the patient to talk freely. They are critical at the beginning of the interview. As the patient talks, ...

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