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Interview And Health Issues

Interview And Health Issues

Research confirms interviewing is an effective system of gathering essential information regarding the personality and character of another person. In the medical profession, interviews are crucial for gathering information on a one-on-one basis, starting with applying to professional schools to daily interviews with patients in various settings. Interviews will always be a part of medicine due to the nature and importance of the information gained. Continually developing and improving techniques in conducting and participating in the interview process will benefit all those who labor in the medical field. As noted above, interviews are a continual process in the medical field.

Healthcare student assessments are completed via interview before acceptance into a professional school.
Healthcare professionals are interviewed during their application process for residency.

Residents are interviewed for important career positions
Researchers interview research subjects
Medical staff interview patients
Attending physicians and professors interview medical school or residency candidates
These are only a few interviews one may participate in over a career. The interview pattern and techniques are similar for the nursing and allied health professions.
Go to: \sIssues of Concern.
Medical professionals consider a medical history of more excellent diagnostic value than a physical exam or laboratory results/investigations. Patient interviews are the most common evaluation tool in clinical medicine. Medical professionals perform hundreds of thousands of workers during a career and are critical in discovering pertinent information leading to a correct diagnosis. The interview also grants therapeutic power; it is used to establish a relationship with the patient and afford empathy and reassurance. Depending on the purpose of the interview, the goals of the patient and the medical professional may be very different. Patients tend to be interested in airing their problems in front of a respected professional, and interviewers look for causes and potential solutions for the patient.

Two types of patient interviews are familiar: problem-oriented and health promotion interviews. The problem-oriented discussion addresses the patient’s current and past health concerns. The health promotion interview assesses risk factors and decreases potential diseases. Developing skills to incorporate the patient into the diagnostic and therapeutic plan of action will improve the patient’s desire to follow through and accomplish measurable and obtainable goals.

As an interview is conducted, one must understand and decipher between the content of what the patient is describing and their emotional and personal insight. The range includes a chronology, onset, description, intensity, exacerbating factors, remitting factors, associated symptoms, social history, medical history, allergies, surgical history, hospitalizations, family medical history, current medications, and other conditions. This information could lead to a diagnostic path for the patient. Furthermore, another aspect of the patient interview is recognizing how the patient expresses information while analyzing meaning through verbal and nonverbal communication. This includes facial expressions, posture, gestures, behaviors, and emotional reactions. Some patient concerns or symptoms may not be expressed directly and must be noted by an astute interviewer. For example, topical avoidance or an abrupt flow change in conversation may be observed. The development of a nonjudgmental interviewing style will likely improve the patient’s disclosure of concerns. Patients rarely express their symptoms in an organized manner; therefore, it will benefit the interviewer to ask open or directional questions that can assist the patient in communicating necessary information during the discussion.

Skills for building relationships with patients include:

Active listening: Interest in the patient without judgment
Empathy: An emotional state of communication and understanding
Concern: Caring for the unique patient
Demonstrate knowledge and experience by asking pertinent questions during the interview.
Interview And Health Issues
Showing empathy may be a simple comment, such as “that sounds like a challenging time,” when the history of a father passing of heart disease at a young age is shared. When appropriate, a reassuring touch or moment of silence may also strengthen relationships with patients.

The first step in the interview includes a formal introduction. Second, look for the immediate demands of the patient. This may include an assessment of the patient’s airway, breathing, and circulation in the emergency room. In other situations, the interviewee may require comfort, possibly a glass of water. Patient interviews are best conducted in private without distractions. Emotions must be assessed promptly in the interview process because one may confuse the history with embellishments and defensiveness.

As the interviewer, it is essential to keep the interview flowing productively and positively. At the beginning of the interview, express time allocation to assist the patient in prioritizing their concerns. This also empowers the patient to feel in control of their problems and the discussion. Furthermore, mix open-ended questions with focus questions. Open-ended questions may allow the patient to express their thoughts and feelings, and focused questions will enable the interviewer to obtain essential details with yes or no answers in a more time-efficient manner. Too many focus questions may cause one to feel a sense of interrogation. Although more efficient at times, a very high number of focus questions may cost the interviewer rapport with the patient.

The first question posed in the interview is often open-ended. For example, “What is the main reason you seek medical assistance today?” This allows the interviewer to enable the patient to share their concerns, and the interviewer can show they are actively listening. This includes listening without judgment and displaying Concern for the patient during communication. Typically, patients only sometimes express their main complaint right away. Therefore, as the patient concludes their thoughts, an interviewer may find success by inquiring further, “Is there anything else you would like to share at this time?” Some patients will express anxiety, anger, helplessness, or other emotions. Recognizing the patient’s feelings are valid and offering reassurance may build a meaningful relationship. [1]

During the interview, meaningful questions inquired positively will reduce defensiveness from the patient. Often this can be accomplished by suggesting or sharing a typical behavior associated with the patient’s actions. For example, the interviewer may convey the commonality of people consuming alcohol under stress. It then becomes acceptable to inquire if this is also occurring with the patient. The patient may feel a sense of trust and therefore share pertinent information.

After the patient interview, an appropriate transition statement to begin the physical exam may be, “Is there anything else that you would like to share with me before I start the physical examination?” This statement serves two purposes. First, it elicits any additional information the patient deems necessary, and second, it signals a transition to the physical exam. Upon conclusion of the physical exam, it is then appropriate to discuss with the patient findings of the physical exam and the next course of action. This includes informing the patient of labs and imaging required for further information regarding the patient’s illness, as well as medications and intravenous (IV) fluids that will be administered to treat the patient. Lastly, discussing the probable follow-up plan and further treatment is essential before concluding the interview. In the outpatient setting, this may include admission to the hospital or going home and returning for a follow-up appointment at a designated time. Inpatient setting may consist of access to the hospital, discharge, follow-up with a physician in the outpatient setting, or discussion of further testing and examinations for a final resolution. The final phase of communication in the interview process will provide the patient with necessary information regarding their illness and build rapport in hopes the patient will become increasingly involved in their health.

Life-long learning and practice of the medical interview will improve one’s ability to reach patients more understanding and caringly. Research provides evidence that even novice medical interviewers can be taught to be more effective in the interview process. Furthermore, studies confirm that as students begin interviewing, they benefit from a set dialogue while incorporating other aspects of positive interview skills, as explained above. As students progress in their careers, they can adopt a more open-ended interview method. Simulated patient encounters have become an aspect of education and examinations in health professional schools. These patient encounters are recorded, and proctors provide feedback on student performance during the meeting. It is perfectly acceptable to ask a more experienced interviewer to review your patient interviews and provide constructive criticism to enhance interview skills. Due to the importance of the interview aspect of an appointment, simulated patient encounters have become part of the licensing exams for physicians and other health professionals.

Veterans, as well as inexperienced interviewers, perform many common mistakes during medical interviews. As described above, these mistakes decrease the patient’s trust in the interviewer and may lead to more medical errors. Often mistakes are made when interviewers have an emotional detachment from the patient or when there are perceived or real-time constraints. Avoiding the following common mistakes will provide improved medical care.

Common Interview Mistakes

Too many focused questions
Ignoring the patient’s emotions
Arriving at diagnosis or shortening the differential too early in the interview process
Refusing to return to the patient for further information or clarifications
No introductions, no regard for the patient’s comfort, no relationship building
No open-ended questions
Interruptions to the interview process[2]
Go to: \sClinical Significance
There are many ways in which effective patient communication can improve clinical outcomes and safety for patients.

Effective patient communication is essential when identifying the necessary labs, procedures, and imaging required to diagnose a patient’s condition. This initial communication also assists in developing a differential diagnosis on which medical treatment is based. The quality of medical treatment is primarily based on the initial patient interaction. Furthermore, a positive patient relationship improves patient outcomes, including the ability to return to work promptly and increased functionality after treatment.

Effective patient communication generates an increase in positive outcomes. These positive outcomes may include but are not limited to improved compliance with medical plans, patient self-regulation of diet and medications, and improvement in patient’s coping mechanisms. These outcomes improve the patient’s functional status after treatment. For example, chronic diseases are significantly impacted by improved patient relationships and communication due to the complex nature of chronic diseases and extensive treatment.

Joint medical-decision making occurs when a patient and healthcare professional discuss treatment options and desired outcomes for the patient. It improves the patient’s understanding of what their products will likely be with medical treatment and adherence to that treatment. This form of medical decision-making is more successful with positive patient communication developed in the initial interview. Overall, this communication style improves the satisfaction of the treatment and the healthcare professional’s opinion.

Improving patient communication also increases trust in the healthcare provider and may allow patients to consider all their options while making thoughtful treatment decisions. One such example is a “wait and see” recommendation. A patient may forego an expensive procedure or imaging study and await improvement. Over time, the lab or imaging may be optional. This recommendation is likely successful with mutual trust between the healthcare provider and the patient. A patient who trusts their interviewer is also more likely to communicate private and personal information regarding themselves and their lifestyle. This may lead to improved treatment and outcomes. [2]

Go to: \sOther Issues
Research Interviews

Medical research investigators use interviews to collect data. This is especially true for qualitative research regarding patient experience. Research interviews have unique challenges. Scientists studying research interviews recommend those with extensive experience supervise new interviewers. Also, new researchers must perform practice interviews with opportunities for feedback regarding interview skills. These pilot interviews will assist new researchers and avoid misunderstandings and assumptions during their initial research interviews. [3] It is also essential to prevent interviewing bias. One example of an interview bias occurs when interviewing young subjects. Children at two years old consistently display a bias to “yes” in yes or no questions, whereas 4- and 5-year-olds exhibited a “no” answer bias. The tendency diminishes significantly after five years of age as long as the question is understandable to the child. [4] Another example of an interview bias involves sensitive questions regarding sexual behaviors. Compared to face-to-face interviews, these biases were reduced with audio, computer-assisted self-interview (interviews completed over a computer interface). [5] Finally, interview bias occurs when interviewers choose their study subjects. This bias can be reduced with strict sampling protocols, consistently trained interviewers, and checking responses to ensure interviewers are sampling similar groups. [6]

A unique aspect of research interviewing is selecting the most suitable individuals to interview for the research question to be answered effectively and thoroughly. This should be taken seriously to optimize the results of the research project. Depending on the research question, interviews require many of the same skills as medical interviews, for example, developing rapport and mixing open-ended questions with focus questions. Furthermore, creating an open mind and active listening is essential for researchers to conduct adequate research interviews.

Research types of inquiry differ from medical interviews. For example, researchers are not trying to pinpoint the shortest differential diagnosis. Researchers often search for diverse information or the consensus of a group or subset of individuals.

A unique aspect of research interviews involves ethical issues. Thus, the questions in a research study must be approved by a separate and third-party council set up to review all aspects of research projects. One ethical issue includes extracting information without harming the study’s participants. Another moral issue consists of the exploitation of interviewees. If the interview questions are likely to cause emotional or mental harm to those interviewed, counseling must be provided after the questioning. Anonymity must be secured for interviewed students because information may be sensitive. Interviewees must provide signed written consent when involved in a research study.

The last step in the research interview is analyzing the information obtained. This involves specialized statistical skills often completed by professionals with expertise in this area. [7]

Job Interviews

Unlike patient and research interviews, job, residency, and academic institution interviews are competitive. The candidate should be more prepared than the interviewer, and they should be able to ask pertinent questions that demonstrate they have seriously looked into the position and organization with the intent to be a contributing member of that organization.

These types of interviews are like academic assessments; they are staged events. Therefore, adequate preparation will significantly improve the likelihood of a successful interview. Preparation includes understanding the organization, understanding oneself, appearing interested, and practicing clear explanations.

An interviewee must study the organization for which they want to work. The internet allows anyone to efficiently research an organization, job requirements, and the interview committee. Expressing an understanding of the organization during the interview will display dedication and interest as the interviewee may tailor their explanations regarding a proposal to fulfill the specific position. This may allow for a more productive discussion. Ultimately, the interviewer is seeking someone to meet a need in that organization, and the organization does possess a fear of making a hiring misstep. The interviewer uses questions to minimize that risk. Four main questions must be asked and answered during an interview. The questions include:

Can this person do the job?
Is this person liked?
Is this person risky in some way?
Will the salary be sufficient?
The next step in the job interview process includes two aspects of self-analysis. First, interviewees must discover their unique qualities, which is likely the most critical skill. Life experiences, awards received, and academic grades are all examples of this. Second, each piece of knowledge and its characteristics must be translated into qualities that will benefit the organization and fulfill the job requirement. For instance, if a person has high grades or awards, they may be referred to as a “hard worker.” Understanding oneself will not only lead to the desired job, but it will also compel a person to be very powerful in “selling themselves” during an interview. Consider job suitability as well as weaknesses in the interviewing process. Although the interviewing organization may engage in some recruitment during the interview process, this is far outweighed by the interviewee’s need to answer the four questions listed above appropriately.

The next critical step in the interview process is demonstrating interest in the job and organization. Personal phone calls and confirmation emails before the interview illustrate an organization’s interest. During the interview, research is necessary; however, prepared, well-thought-out questions based on the organization are also essential. These questions frequently involve the person conducting the interview. “What is your experience working at this organization?” for example.

Furthermore, the interviewee may seek information about the qualities of the organization’s employees. “Can you describe your ideal candidate?” for example. “What do I need to do to get this job?” is a good closing question expressing your interest.

Interviewees can demonstrate their interest in the organization by taking thorough notes during the interview; this will help them remember various aspects of each organization over time. Following the discussion, the candidate should express continued interest in the job through personal emails, phone calls, and letters.

Professional attire conveys commitment and interest in a program. Business suits or neutral colors are advised. In these situations, it is often preferable to be overdressed rather than underdressed. Other quick interview etiquette tips include arriving on time and respecting the interviewer’s time. It is also critical to turn off cell phones during the interview. Respond promptly to all follow-up phone calls and emails to set yourself apart from other interview candidates.

Before the interview, successful interviewees thoroughly practice interview questions. Many likely interview questions can be found in textbooks, easily accessible online. Remember that the most valuable questions are related to the four main questions above. “Why should the organization choose you over another candidate?” is a question one should be prepared to answer. These questions should be answered with a strong understanding of the interviewee’s unique characteristics that will benefit coworkers and the organization. Experiment with providing examples demonstrating these distinct characteristics and how they have helped others in the past. Be patient when answering interview questions, knowing that a tiny mistake, such as saying something negative about another person or a previous organization with which the candidate was affiliated, can cost you an opportunity. Also, be prepared to explain any gaps in time on a resume, leave a job, and positively overcome challenges. [8]

Nonverbal communication mannerisms must be considered in addition to verbal communication mannerisms. This includes posture, eye contact, voice volume, and time management when expressing interest in a job. All of these characteristics, with practice, may provide a positive interview experience.

Examples of Questions

“What exactly are you looking for in a job?”
“Tell me about your most recent job.”
“What was the most challenging part?”
“What was your proudest achievement?”
“What brought you here?”
“How do you collaborate with others?”
“Who was the most difficult person to work with in your previous jobs?”
“How do you deal with criticism?”
“How do you deal with change?”
“What distinguishes you from the other candidates?”
“Talk about a failure period.”
“How does this position fit into your long-term plans?”
“What are your objectives?”
“What kind of salary, benefits, and working hours do you anticipate?”
Take note of the questions that organizations should avoid. These include questions about nationality, ancestry, religion, family situation, and military service, among other things.

Interviewing is a method. A person will almost certainly have to interview for several jobs before accepting a job offer. Many factors a candidate cannot control; thus, the more interviews a candidate has, the more likely they will be hired, matched, or accepted. Focusing on the interviewing process and research and practice will yield positive results. [9][10]

Visit: Improving Healthcare Team Outcomes
Learning how to conduct a medical interview is a fundamental skill that all clinical providers must possess. Patients frequently present with complex scenarios and may have underlying fears, prejudices, or biases toward the medical profession. Healthcare providers must navigate these emotions with care and respect to improve patient interactions and outcomes. In the most difficult circumstances, a well-conducted medical interview can lead to better patient care and trust in the healthcare team itself.
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