The doctor of the future will give no medicine but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease.
Every patient interaction should conclude with a structured end of the interview that usually consists of sharing the information you have obtained with the patient, collaborating with her or him to arrive at an acceptable plan and, where necessary, motivating the patient to act on it. The skills used in the beginning and middle of the interview allow you to gather information from the patient, primarily by asking questions, and establish a relationship with her or him. At some point in the interaction, usually after an appropriate physical exam and/or review of laboratory data, you will need to share your impressions and engage in a conversation about the next steps of diagnosis and/or treatment. You can be tempted to educate and/or motivate patients earlier in the interview, but this vital activity is usually best done after data gathering is completed. A successful end of the interview leads to better health outcomes, because patients are more likely to agree with plans and carry them out. Patients take the pills we prescribe, go for X-rays and tests, and keep their appointments. We do not do it for them. Therefore, the end of the interview is a key element in successful health outcomes.1–6 See also doc.com Modules 10–12.7–9
The structure of the end of the interview depends on the needs of the patient. Consider these patients during a single clinic morning. The first patient, new to your care and similar to Mrs. Jones, requires information on your findings from the history and physical examination, answers to questions, and diagnostic and treatment plans for the future. The second is a patient making a follow-up visit to discuss the results of a recent test. Unfortunately, you have discovered a life-threatening disease and you need to deliver bad news to this patient. In this case, you devote a large part of the interaction, following the middle of the interview and physical examination, to delivering the bad news and making subsequent plans. The third patient asks for no information but you want to discuss a topic that the patient does not ask about. You first listen to the patient's needs using patient-centered interviewing skills and elicit necessary details using clinician-centered skills. Having learned that the patient smokes cigarettes you want to discuss smoking cessation and you devote the end of the interview to motivating the patient to consider smoking cessation.
The end of the interview thus involves issues stemming from either the beginning or middle of the current interview, or from a previous interview; and requires effective skills in delivering information, motivating, and sharing decisions with patients.10,11 The end of the interview guide that follows, outlined ...