I wanted to use that title because it reminds me of Monty Python and makes me laugh.
But seriously, one of the things they've stressed to us in our communication class is to avoid rapid fire closed-end questions and instead ask open-ended questions when interviewing clients (some are really more open-ended invitations). According to our professors, you can get more information that way in the same amount of time all while establishing better rapport. (Seems counter-intuitive that one would get more information in the same amount of time without guiding the client to focus on what you want to hear but apparently it's true in most cases).
Some examples-- "I'd like you to take a minute or two to tell me about Pip."
"Describe what you saw."
"What are your ideas about this problem?"
"What kinds of changes have you been seeing in Blue?"
It's easier said then done. In emergency, I used more closed-ended questions than open-ended questions. At Cornell, we have a list of questions on the history form such as travel history, diet etc and so my client interactions often turn into the Spanish Inquisition, which is even more awkward when you are consciously trying not to ask too many closed ended questions because then you get flustered trying to think of other ways to phrase things.
What are your favorite phrases for eliciting information from clients? Do you actively think about using closed-ended versus open-ended questions? Just curious... Or, do you ever feel like you are being interrogated by your doctor?
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I can tell you that when I go into a room on a non-emergent case (like vomiting, diarrhea, etc), my first question is - "tell me when you first noticed this problem." I ask the owner to take me through it from the start. That can be extremely time-consuming in emergency medicine, and there are times that I can't do that. Inevitably though, I come across cases where a better history would have been crucial in making a diagnosis. I can't stress enough how important history is.
ReplyDeleteA good example was a recent case I saw. A small breed dog went to its rDVM for "collapsing". It was an intact, young female (3 years old). They did xrays and saw a fluid-filled uterus. They diagnosed pyometra and did surgery. They found out in surgery that the dog was pregnant - and that the collapsing episodes likely had nothing to do with the pregnancy. They sent the dog home assuming they'd fix it, however.
The owners came to me several days later because the dog was still not well. They thought it stemmed from the surgery.
I spent 20 minutes (it was very late at night, so I had the luxury) talking to them about the dog's history. What had actually been happening sounded like neck pain - the dog started out unable to lower its head to drink, so they had to elevate the food. Then it's front legs started collapsing out from under it, and it became lethargic. It stopped being able to jump up on the couch. The dog never vomited, never had diarrhea, had a great appetite, and a normal attitude. When I did my PE - the dog had SCREAMING neck pain.
Now, on steroids and pain medications (neuro consult out of the question financially) - the dog is doing great.
The history guided me! Without it, I would have been assuming this was a problem related to the pregnancy and/or surgery.
I usually just simply ask what's been going, and then ask some specific questions as we go along.
ReplyDeleteI have to be very concious of asking open ended questions and then if they stray too far afield, I try to gently (or not so gently) reign them in). I usually ask things like 'can u tell me what happened?' or 'how are u doing?' which often elicits an 'ok' or 'fine' but sometimes the floodgates open and the lifestory comes pouring out..... If they so ok or fine, my cynical, suspicous nature always kicks in, I immediately think, if you are fine or ok, then what do u need from me? :)
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