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INTRODUCTION

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.

Thomas Edison, 1902

In the beginning and middle of the interview you gathered information from the patient and established a relationship with him/her. At some point in the interaction, usually after an appropriate physical exam and/or review of laboratory data, you need to share your impressions and engage in a conversation about the next steps of diagnosis and/or treatment. You may 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 understand and 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.16 See also DocCom Modules 10 to 12.79

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 Ms. 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 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—the patient's use of tobacco. You devote the end of this interview to motivating the patient to consider quitting smoking.

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 in Table 6-1, provides a pathway for ending most clinical interviews. Sections entitled “End of the Interview—Giving Difficult News” and “End of the Interview—Motivating Patients for Behavioral Change” describe steps for those tasks.

TABLE 6-1

End of the Interview—General Guide

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