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Chapter 4. Clinician-Centered Interviewing

Auguste H. Fortin VI, MD, MPH; Francesca C. Dwamena, MD, MS; Robert C. Smith, MD, MS

You have completed the patient-centered part of the interview of the patient from Chapter 3 (38-year-old woman with left-sided neck pain for 1 week after discovering that her husband was having an affair). Now you need to transition to the clinician-centered interview to learn more about the patient and her neck pain.

  • What further details about the neck pain do you need to know?
  • Which aspects of the social history will be most important?
  • How will you respond if the patient starts to cry when you inquire about her home life?

The patient-centered part of the interview yields the patient's personal description of his or her symptom and its impact on the patient's life, including any resulting emotional response. Consider this the patient's story of the history of present illness (HPI) (see Chapter 3).

Although the patient-centered interview provides important psychosocial information, it is rarely sufficient to make the diagnosis for a given symptom. More details (eg, symptom characteristics, the family history and social history) are needed to fill in the database, which is usually done in the clinician-centered interview.1 Here clinicians inquire about symptom information not yet mentioned by the patient in order to complete the HPI. Other aspects of the patient's life and history are explored to consider diseases apart from the present illness, assess for disease risk, and get to know the patient better.

In the clinician-centered interview, the patient is led through a series of open-ended followed by closed-ended questions, moving from general information to specific details.

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Clinician-centered interviewingThe clinician takes charge of the interaction to acquire specific details not provided already by the patient, usually to diagnose disease or to fill in the routine database.
Closed-ended questionsCan be answered with “yes,” “no,” a number, or a short answer. For example, “When did your headache start?” “Where is it located?”
Open-ended questions/requestsEncourage the patients to tell a narrative or story. For example, “Tell me more about your headache.” ”Go on.”

The clinician expands the symptom description and obtains any related symptoms, details, and other relevant data (eg, medications, hospitals, doctor's visits) not yet introduced by the patient (Table 4–1).

Table 4–1. Filling in the History of Present Illness.
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Table 4–1. Filling in the History of Present Illness.

  1. Define the cardinal features of the patient's chief concern.

  2. Define the cardinal features of other symptoms (those already mentioned by the patient and those not yet introduced) in the organ system of the patient's chief concern.

  3. Inquire about relevant symptoms outside the involved system.

  4. Inquire about relevant nonsymptom (secondary) data.

Expanding Description of Symptoms

Symptoms already mentioned by the patient usually need further explanation. To fully understand a symptom, clinicians need to know its ...

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