INTRODUCTION TO

THE INTERVIEWING
PROCESS
DR. MUHAMMAD MUSTAFA QAMAR
ASSISTANT PROFESSOR, SMC

mustafaqamar.com
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THE PATIENT INTERVIEW AND HISTORY

 Patient interview

 First step in examination

process
 Establish a relationship with
the patient
 Keep in mind the education,
culture & religion of patient
 Treat the patient with
Compassion & Care
 DO’S
Do use a sequence of questions that begins
open—ended questions.
Do leave closed—ended questions for the end.
Do select a private location where
confidentiality can be maintained
Do listen attentively
Do ask one question at a time
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 DO’S
Do encourage the client to ask questions
Do listen with the intention of assessing the
client level of understanding of his/her medical
issue.
Do correlates signs and symptoms with medical
history and objective findings to rule out
systemic disease

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 DON'T
Don’t jump to premature conclusion
Don't interrupt or take over the conversation
when the client is speaking.
Don't destroy helpful open-ended questions
Don't use professional or medical terms
Don't overreact to information presented.
Don't use leading questions.
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 METHODS OF CHARTING

 SOAP – documentation in a logical

manner
 Subjective data – what the patient
says
 Objective data – measurable
information
 Assessment – diagnosis or
impression of problem
 Plan of action – options for
treatment, follow-up 7
 THE PATIENT INTERVIEW AND HISTORY
 Patient responsibilities
 Provide accurate information about
past medical conditions
 Participate in health-care decisions
 Follow PT’s orders for treatment
Telescoping : Clients may forget,
underreport, or combine separate
health events into a single memory 8
 THE PATIENT INTERVIEW AND HISTORY:
INTERVIEWING SKILLS
 Practice effective listening
 Active listener – hear, think about, and respond

 Be aware of nonverbal clues and body language

 Have a broad knowledge base

 Necessary to ask appropriate questions

 Summarize to form a general picture

 Verify information

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 THE PATIENT INTERVIEW AND HISTORY (CONT.)
Eight steps to a successful interview

1. Do research before the interview

 Review patient records
 Be sure test and lab results are on the chart

2. Plan the interview

 Be organized before starting the interview
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 THE PATIENT INTERVIEW AND HISTORY (CONT.)

3. Make the patient feel at ease

 Icebreakers
 Appear relaxed 8 Steps (cont.)

 Eye contact

4. Ask the patient for an interview

 Makes the patient feel more comfortable
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 THE PATIENT INTERVIEW AND HISTORY (CONT.)
5. Ensure privacy / no interruptions
 Close door

8 Steps (cont.)
6. Be respectful with sensitive topics
 Watch for nonverbal clues

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 THE PATIENT INTERVIEW AND HISTORY (CONT.)
7. Do not diagnose or give an opinion
 Refer questions to physician
 Do not go beyond your scope of practice
8 Steps (cont.)

8. Formulate a general picture

 Summarize key points
 Ask if patient has questions or needs to add
additional information 13
 Correct!
APPLY YOUR KNOWLEDGE
1. What type of question is the following: “How have
you been managing your diabetes?”
ANSWER: An open-ended question which will allow the patient to explain the situation more clearly.

2. How would you use mirroring if the patient made the following
statement during an interview? “I just cannot seem to stay on a
diet no matter how hard I try.”

ANSWER: For example, you might say, “You are finding it difficult to stay on a diet.”

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 INTERVIEWING TECHNIQUE

 Open ended question

 Closed ended question
 Funnel sequence or technique
 Paraphrasing technique

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 INTERVIEWING TOOLS

 Outcome measure…documenting the

effectiveness of treatment… (using standardized
tool)

 Pain scale… VAS

 Manual Muscle testing

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 RECORDING THE PATIENT’S MEDICAL
HISTORY
 Includes pertinent information
 Patient and patient’s family
 Age, previous illness, surgical history, allergies, medications history, and family
medical history
 Questioning technique – OPQRST
 Onset
 Provoke
 Quality of pain
 Region where located
 Signs and symptoms
 Timing
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CORE INTERVIEW
Chief Complaint (Onset)
• Tell me why you are here today.
• Tell me about your injury.
Alternate question: What do you think is causing your problem/pain?

FUPs: How did this injury or illness begin?

° Was your injury or illness associated with a fall, trauma, assault, or repetitive activity (e.g., painting, cleaning, gardening,
filing papers, driving)?
° Have you been hit, kicked, or pushed?
° When did the present problem arise and did it occur gradually or suddenly?
Systemic disease: Gradual onset without known cause, progressive, cyclical onset: worse, better, worse.
 LOCATION

Do you have any pain associated with your injury or illness?

It yes, tell me aboul it.
• Show me exactly where your pain is located.
FUPs: Do you have this same pain anywhere else?
° Do you have any other pain or symptoms anywhere else?
° If yes, what causes the pain or symptoms to occur in this other
area?
 DESCRIPTION

• What does it feel like?

Has the pain changed in quality, intensity, frequency, or duration
(how long it lasts] since it first began?

Pattern
• Tell me about the pattern of your pain or symptoms,
Alternate question: When does your back/shoulder [name the
body part] hurt?
° How does your pain/symptom’s change with time?
° Are your symptoms worse in the morning or in the evening?

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 FREQUENCY

• How often does the pain/symptom’s occur?

FUPs: Is your pain constant, or does it come and go
intermittent?
Are you having this pain now?
° Did you notice these symptoms this morning?
Duration
• How long does the pain/symptom’s last?
Systemic disease: Constant.

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 INTENSITY

On a scale from 0 to 10, with 0 being no pain and 10 being the worst
pain you have experienced with this condition,
what level of pain do you have right now?
Alternate question: How strong is your pain?
1 = Mild
2 = Moderate
3 • Severe
Systemic disease: Pain tends to be intense.

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 ASSOCIATED SYMPTOMS

• What other symptoms have you had that you can associate with this problem?

FUPs: Have you experienced any of the following?

• Blood in urine, stool, vomit, mucous • Cough • Difficulty swallowing/speaking
• Dizziness, fainting, blackouts • Dribbling or leaking urine • Memory loss
• Fever, chills, sweats [day or night| • Heart palpitations or fluttering • Confusion
• Nausea, vomiting, loss of appetite • Numbness or tingling • Sudden weakness

Systemic disease:
Presence of symptoms bilaterally (e.g., edema, nail bed changes, bilateral weakness,
paresthesia, tingling, burning). Determine the frequency, duration, intensity, and
pattern of symptoms.
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 AGGRAVATING & RELIEVING FACTORS

• What kinds of things affect the pain?

FUPs: What makes your pain/symptoms worse (e.g., eating,
exercise, rest, specific positions, excitement, stress)?
Relieving Factors
• Who makes it better?
Systemic disease: Unrelieved by change in position or by rest,
* How does rest affect the pain/symptoms?
FUPs: Are your symptoms aggravated or relieved by any activities?
If yes, what?
° How has this problem affected your daily life at work or at home?
0 How has it affected your ability to care for yourself without
assistance |e.g., dress, bathe, cook, drivel? 25
 MEDICAL TREATMENT AND MEDICATIONS
 • What medical treatment have you had for this condition?

 FUPs: Have you been treated by a physical therapist for this

condition before? If yes:
 • When?

 0 Where?

 ° How long?

 ° What helped?

 0 What didn't help?

 ° Was there any treatment that made your symptoms worse? If yes,
please elaborate 26
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MEDICATION
 • Are you taking any prescription or
over-the-counter medications?
 FUPs: If no, you may have to probe
further regarding use of laxatives,
aspirin etc. If yes:
 • What medication do you take?

 ° How often
 CURRENT LEVEL OF FITNESS

• What is your present exercise level?

FUPs: What type of exercise or sports do you participate in?
Ask about frequency, duration, intensity
Dyspnea: Do you ever experience any shortness of breath (SOB) during
any activities
FUPs: Are you ever short of breath without exercising?
• If yes, how often?
• When does this occur?
• Do you ever wake up at night and feel breathless? If yes, how often?
• When does this occur? 28
 SLEEP-RELATED HISTORY

• Can you get to sleep at night? If no, try to determine

whether the reason is due to the sudden decrease in
activity and quiet,
• Are you able to lie or sleep on the painful side? If yes, the
condition may be considered to be chronic, and treatment
would be more vigorous than if no, indicating a more acute
condition that requires more conservative treatment.
• Are you ever wakened from a deep sleep by pain?

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 STRESS

• What major life changes or stresses have you encountered that you
would associate with your injury/illness?
Alternate question: What situations in your life are "stressors" for
you?
• On a scale from 0 to 10, with 0 being no stress and 10 being the
most extreme stress you have ever experienced, in general.
what number rating would you give to your stress at this time in your
life?
» What number would you assign to your level of stress today?

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 FINAL QUESTION

 • Do you wish to tell me anything else about your injury,

your health, or your present symptoms that we have not
discussed yet?
 Alternate question: Is there anything else you think is
important about your condition that we haven't discussed
yet?

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 Wisdom is to the soul what health is to the
body.

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