The medical interview is the major medium of patient care and is therefore of central importance to practitioners. The interview principally determines the accuracy and completeness of data elicited from the patient. It is the most important factor in determining patient adherence to the plans agreed on—whether to take a medication, undergo a test, or change a diet. The interview is the keystone of patient satisfaction. More than 80% of diagnoses derive from the interview. Interview-related factors have been shown to impact major outcomes of care such as physiologic responses, symptom resolution, pain control, functional status, and emotional health. Quality factors influenced or determined by the medical interview include malpractice suits and their resolution, completeness and accuracy of elicited information, time efficiency, elimination of "doorknob" questions at the closing of the interview, and patient satisfaction.
The interview is therefore a major determinant of professional success, yet fewer than 10% of medical practitioners have spent any time since medical school working on their interviewing ability. When asked, most physicians indicate that they have no plan or approach to monitoring, maintaining, or improving this critical skill. Can you imagine a professional athlete, musician, or pilot not practicing or planning to do so? One would question their commitment and their competence.
The interview, which is also centrally important to practitioners' sense of well-being in their work, is the factor that most influences practitioner satisfaction with each individual encounter. Physicians with high career dissatisfaction attribute this to a great extent to unsatisfactory relationships with patients. Physicians with high job satisfaction have a significant interest in the psychosocial aspects of care, relate effectively with patients, and are capable of managing difficult patient situations.
The central importance of the interview derives from its epidemiology. For most physicians (except noninterventional radiologists, pathologists, and some surgeons), it is more prevalent than any other activity in their work or their lives. The average lengths of time per patient visit for internists, average family practitioners, and pediatricians are 15, 12, and 8 minutes, respectively, and these groups account for 75% of visits. The average overall time for physicians is 6 minutes per visit, a rate curiously constant in the United States, the United Kingdom, The Netherlands, and elsewhere. Some other physicians, who are bringing the average down to 6 minutes, are obviously moving too quickly.
Making conservative assumptions about how many hours a practitioner will work over a 40-year professional lifetime, a generalist will have around 250,000 patient encounters. Each interview can be the source of satisfaction or distress, of learning or apathy, of efficiency or wasted effort (Table 1–1), of personal growth and inspiration or of dispiriting discouragement. Few physicians, however, plan, or even think about, how to improve the balance of the desirable goals of satisfaction, learning, and efficiency for themselves.
Table 1–1. Gains from improved interviewing techniques....