Interviewing and

the Health History

by
Arif Yahya

THE FORMAT OF THE COMPREHENSIVE

HEALTH HISTORY
Identifying Data
Source and Reliability of History (smbr & hal yg dpt
dprcya )

Chief Complaint (kluhan utama)

History of Present Illness (yg drskn skrg)
Medications, Allergies, Tobacco, Alcohol and
Drugs
Past History (
Childhood Illness
Adult Illness: Medical, Surgical, Ob/Gyn,
Psychiatric, Health Maintenance
Family History

Getting Ready:
The Approach to the Interview
Taking Time for Self-Reflection
Self-reflection is a continual part of
professional development in clinical
work. It brings a deepening personal
awareness to our work with patients
and is one of the most rewarding
aspects of providing patient care.

Getting Ready:
The Approach to the Interview
Reviewing the Chart
Before seeing the patient, review his or her
medical record, or chart. The purpose of
reviewing the chart is partly to gather
information and partly to develop ideas
about what to explore with the patient. Look
closely at the identifying data (age, gender,
address, health insurance), the problem list,
the medication list, and other details, such
as the documentation of allergies.

Getting Ready:
The Approach to the Interview
Setting Goals for the Interview
Before you begin talking with a
patient, it is important to clarify your
goals for the interview. As a student,
your goal may be to obtain a
complete health history so that you
can submit a write up to your
teacher.

Getting Ready:
The Approach to the Interview
Reviewing Clinician Behavior and
Appearance
Just as you observe the patient
throughout the interview, the patient
will be watching you. Consciously or
not, you send messages through
both your words and your behavior.
Be sensitive to those messages and
manage them as well as you can.

Getting Ready:
The Approach to the Interview
Improving the Environment
Try to make the setting as private
and comfortable as possible.
Although you may have to talk with
the patientunder difficult
circumstances, such as a two-bed
room or the corridor of a busy
emergency department,
a proper environment improves
communication.

Getting Ready:
The Approach to the Interview
Taking Notes
As a novice you will need to write
down much of what you learn during
the interview. Even though
experienced clinicians seem to
remember a great deal of the
interview without taking notes, no
one can remember
all the details of a comprehensive
history.

Learning About the Patient:

The Process of Interviewing
THE SEQUENCE OF THE INTERVIEW (urtn intrview)
Greeting the patient and establishing rapport
Inviting the patients story
Establishing the agenda for the interview
Expanding and clarifying the patients story;
generating and testing diagnostic (see below)
Hypotheses
Creating a shared understanding of the problem (see
below)
Negotiating a plan
(includes further evaluation, treatment, and patient education)
Planning for follow-up and closing the interview.

Expanding and Clarifying the Health

History (the Patients Perspective)

THE SEVEN ATTRIBUTES OF A SYMPTOM

1. Location. Where is it? Does it radiate?
2. Quality. What is it like?
3. Quantity or severity.
How bad is it? (For pain, ask for a rating on a scale of 1-10.)
4. Timing.
When did (does) it start? How long did (does) it last? How often did
(does) it come?
5. Setting in which it occurs.
Include environmental factors, personal
activities, emotional
reactions, or other circumstances that may have contributed to the
illness.
6. Remitting or exacerbating factors.
Does anything make it better or worse?
7. Associated manifestations.

Creating a shared
understanding of the problem
EXPLORING THE PATIENTS PERSPECTIVE
The patients thoughts about the nature and the
cause of the problem
The patients feelings, especially fears, about the
problem
The patients expectations of the clinician and
health care
The effect of the problem on the patients life
Prior personal or family experiences that are similar
Therapeutic responses the patient has already tried

Facilitating the Patients Story:

The Techniques of Skilled Interviewing
THE TECHNIQUES OF SKILLED INTERVIEWING
Active listening
Adaptive questioning (See below)
Nonverbal communication
Facilitation
Echoing
Empathic responses
Validation
Reassurance
Summarization
Highlighting transitions

Facilitating the Patients Story:

The Techniques of Skilled Interviewing
ADAPTIVE QUESTIONING:
OPTIONS FOR CLARIFYING THE PATIENTS
STORY
Directed questioningfrom general to specific
Questioning to elicit a graded response
Asking a series of questions, one at a time
Offering multiple choices for answers
Clarifying what the patient means

Adapting Interviewing Techniques

to Specific Situations

The
The
The
The
The
The
The
The
The
The
The
The
The

Silent Patient
Talkative Patient
Anxious Patient
Crying Patient
Confusing Patient
Angry or Disruptive Patient
Patient With a Language Barrier
Patient With Reading Problems
Patient With Impaired Hearing
Patient With Impaired Vision
Patient With Limited Intelligence
Poor Historian
Patient With Personal Problems

Special Aspects of
Interviewing

Cultural Competence
The Alcohol and Drug History
The Sexual History
Domestic and Physical Violence
The Mental Health History
Death and the Dying Patient
Sexuality in the ClinicianPatient
Relationship

Ethical Considerations
THE TAVISTOCK PRINCIPLES
Rights: People have a right to health and health care.
Balance: Care of individual patients is central, but the health of
populations is also
our concern.
Comprehensiveness: In addition to treating illness, we have an
obligation to
ease suffering, minimize disability, prevent disease, and promote health.
Cooperation: Health care succeeds only if we cooperate with those
we serve,
each other, and those in other sectors.
Improvement: Improving health care is a serious and continuing
responsibility.
Safety: Do no harm.
Openness: Being open, honest, and trustworthy is vital in health
care.

Interviewing Patients of
Different Ages
Talking With Children
Establishing Rapport (
Working With Families
MULTIPLE AGENDAS
THE FAMILY AS A RESOURCE
HIDDEN AGENDAS

Talking With Adolescents

Talking With Aging Patients

Talking With Aging Patients

ACTIVITIES OF DAILY LIVING (ADLs)
Physical ADLs Instrumental ADLs
Bathing Using the telephone
Dressing Shopping
Toileting Preparing food
Transfers Housekeeping
Continence Laundry
Feeding Transportation
Managing moneyTaking medicine