Interviewing quiet patients

[lalab]

We are currently practicing our history taking and I am at a loss on how to establish efficient rapport with patients who don't say much.

 

What are some strategies you use in those cases?

[ploughboy]

We are currently practicing our history taking and I am at a loss on how to establish efficient rapport with patients who don't say much.

 

What are some strategies you use in those cases?

 

Depends why they're not saying much. If they're delirious or demented, you're probably not gonna get much out of them no matter what you do. You're likewise euchred if the patient isn't talking because The Voices will punish him if he reveals their secrets.

 

If they're 5 years old and really shy, you can try playing with them and letting them get comfortable with you before asking anything medical (or talk to the parents).

 

If they're old-ish, they might just not be able to hear you. Ask politely if they have any trouble hearing you, and if so talk louder, move to the good ear, have them put in their hearing aid etc.

 

If they're just reserved (or possibly po'd because they're talking to the medical student instead of somebody with MD behind his/her name) you could try moving quickly from the general, open-ended fife-y questions into very directed, closed questions ("sample" "opqrst" etc). Sometimes once people get talking about what's brought them in they'll loosen up a bit and then you can backtrack to the more open-ended questions that are usually asked at the start of the history.

 

Body language and attitude help as well. If you're sort of sidling into the room and timidly saying "Uh, hi, I'm lalab the medical student, and I'm hoping if it's ok with you that...uh...I can ask you a little bit about your um...medical history and uh, why you're here today if that's ok with you?" that might be a little off-putting to some people. Go in with energy and confidence, smile and look 'em in the eye and say something like "Dr. So-and-so has asked me to see how you're doing today. I see you're here for follow-up of your relapsing/remitting fibromyalgia. How's that going?"

[Intrepid86]

We are currently practicing our history taking and I am at a loss on how to establish efficient rapport with patients who don't say much.

 

What are some strategies you use in those cases?

 

I think these patients are easier to interview than the opposite (i.e., people who talk a lot, go on tangents etc where it's often necessary to redirect the conversation back to their chief complaint). As previously suggested, start with open before closed-ended questions. Even if their answers are brief, your line of questioning should still elicit all relevant history to get an accurate impression. Be aware of any emotional cues like passive-aggression or annoyance, which could indicate additional concerns about their situation/environment, and then find ways to make them more comfortable.

[ellorie]

I like to sometimes make some small talk on my way in - like if I see a kid with roller blades, I will ask them if they roller bladed in to the office. Or even things like whether they have been waiting a long time or how they like the room. I think it shows people that you are paying attention to them.

 

Silence is also not always a sign that you don't have rapport - allowing people to have their silence and being respectful of that (while still getting the information you need) is also an appropriate strategy and can be reassuring for some people.

 

If you think you can manage it and you are able to gauge the right moment, sometimes I will say to people "it seems like you're having a hard time talking right now" and see about exploring it - if it seems that they are not talking because they are distressed, I may comment that they seem distressed and see where that goes. I do that in Emergency and often it leads to tears, but I am okay with the tears. Sometimes it's better out than in - you just have to develop a feel for when to try to uncover it and when to just ignore it so that you don't open a can of worms you can't close again. Or I will validate "I know it's hard to talk about this" or "I am sure you have told this story several times already and that can be frustrating".

 

Like ploughboy said - it's all about knowing why they are quiet.

 

If they are quiet and comfortable and cooperative, you can likely use some closed ended questions to get things started and maybe switch back once they start talking - and if they do start talking, don't interrupt them (within reason). If you don't jump right in with another question right away and give a breath, sometimes a longer answer will come.

 

If they are quiet and uncooperative you may have to be more directive about exploring the roots of that and actively building trust and rapport to hopefully deescalate them a bit.