The medical interview, the major medium of patient care, is of central importance to practitioners. A successful interview elicits accurate and complete data. It represents a dialogue that determines whether the patient agrees to take a medication, undergo a test, or change a diet. More than 80% of diagnoses are derived from the interview. The doctor–patient interaction is the keystone of patient satisfaction; moreover, interview-related factors impact major outcomes of care, including physiologic responses, symptom resolution, pain control, functional status, propensity to sue in the event of an adverse outcome, and emotional health. The medical interview also influences the quality of care, including malpractice suits and their resolution, the amount of patient disclosure of difficult or stigmatized information, time efficiency, and the elimination of "doorknob" questions as the interview ends.
Clearly, the interview is a major determinant of professional success. Yet, fewer than 10% of medical practitioners have spent 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 musician, athlete, or pilot not practicing? One would question their commitment and competence or potential for remaining successful.
The interview is also key to a practitioner's sense of professional well-being, as it is the factor that most influences satisfaction with each encounter. Physicians with high career dissatisfaction most often attribute this to unsatisfying communication and relationships with patients. Physicians with high job satisfaction have a significant interest in the psychosocial aspects of care, relate effectively with patients, and are able to manage difficult patient situations.
The central role of the interview derives from its epidemiology as well as its "one-on-one" impact. For most physicians, it is more prevalent than any other activity in their work or their lives. The average length of time per ambulatory patient visit for internists, family practitioners, and pediatricians is about 20 minutes, and these groups account for 75% of doctor visits. The average visit time for all physicians is 6 minutes, a rate curiously constant in the United States, the United Kingdom, The Netherlands, and elsewhere. Physicians who bring the average down to 6 minutes are moving scarily fast.
Making conservative estimates 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 frustration, of learning or apathy, of efficiency or wasted effort (Table 1-1), of personal growth and inspiration or dispiriting discouragement. Despite the importance of performing this complex skill expertly, few physicians plan, or even think about, how to improve patient encounters to reach the desirable goals of satisfaction, learning, and efficiency.
Table 1-1.Gains from improved interviewing techniques.