The lecture presents skills and requirements of the initial interview in dental clinic, how could dentist gain patient rapport and patient's required information to reach diagnosis also identifying pits and errors of initial interview
6. Objectives:
1. Define the objectives of initial interview .
2. Identify the basic interview skills.
3. Learn how to develop patient rapport.
4. Differentiate between types of questions used for the
interview.
5. Learn how to ask questions to gain information
necessary for diagnosis.
6. Learn how to assist the patient narrative
7. Identify interview errors and pitfalls
7. Objectives of the initial interview
1. Establishing the professional relationship
2. Obtaining information
3. Understanding the total patient
8. Objectives of the interview
1-Establishing the professional relationship
Positive interview Cause the patient to be more receptive
to:
the dentist’s professional judgment
the dentist’s treatment recommendations.
Any advice or instructions( better
understood, accepted and followed).
It Help Development of professional competence
9. Objectives of the interview
2-Obtaining information
Interview is different than casual conversation
In an interview one participant makes a conscious
effort to obtain information from the other
A skilled interviewer can achieve this goal while
making the subject feel engaged in pleasant
conversation
10. Objectives of the interview
3-Understanding the total patient
No ideal treatment plan fits and is best for all patients
The most expensive procedure or clinically difficult
procedures couldn't be the best for all patients.
Factors other than the condition of teeth and supporting
structures should be considered that include:
Patient’s desires
Patient capabilities
Systemic health
Occupation
Availability for treatment
11.
12. Basic interviewing skills and
modifying factors
1. Considering the interview as a clinical procedure
2. Initiating the interview
3. Questionaire
4. Taking notes
5. Importance of minimal activity
6. Changing topics
7. Asking questions
8. Basic question types
13. 1-Considering the interview as a
clinical procedure
• Adequate time for the interview must be
scheduled.
• In many cases it produces information more
than the examination itself.
• In modern practice, it is considered
invaluable in the management of patient
with problems that can’t be easily
understood as TMJ disorders
Xerostomia, chronic pain,…..)
Basic interviewing skills and modifying factors
14. 2-Initiating the interview
1-often initiated by a gesture
2-dentist should be aware of the basic reason
of the visit
depend on the 3- opening statement should
reason of the visit
Basic interviewing skills and modifying factors
15. 3-Questionnaire
Advantages Disadvantages
Easy to administer Restricted to certain chosen
Do not require significant questions.
chair side time. Can be misunderstood by
Gives starting point to begin patient.
with. Cover broad area without
focusing .
Basic interviewing skills and modifying factors
16. Interview
Fostering good patient-provider relationship
Provides an opportunity for patient education and
discussion.
Interview allows dentist to observe and evaluate
patient response.
Help to build rapport necessary for effective
professional relations.
Encourage patient to provide greater detail about
selected symptoms.
Basic interviewing skills and modifying factors
17. 3-Questionnaire
Questionnaire is good point
to start with.
Allows dentist to make
certain observations
concerning patient responses.
Medical questionnaire is
useful but not a substitute for
the interview.
Basic interviewing skills and modifying factors
18. 4-Taking notes
Advantages
Most people view note taking
as a sign of interest and
competence and expect it
Disadvantages
May be distracting
Patients may be suspicious of it
Basic interviewing skills and modifying factors
19. Tips helping interview
The less one says and does the more the patient may talk
Direct questioning may be required with less
communicative individuals
Distraction activity should be avoided
Generally the interview should flow without interruption.
For changing topic, wait for a pause or watch for a natural
bridge or explain straight forwardly that it is necessary to
change topic and why.
Basic rule in interview and clinical practice to
Inform before you perform
20. Asking questions
There are three basic question types:
1- Open ended question
2- Closed question
3-Leading question
Basic interviewing skills and modifying factors
21. Question types
Type of question Example
Tell me about the pain .
Open
Close What does the pain feel like
.
Does the pain feel like an
Leading electric shock ?
22. Open ended question
Cover broad subject area
Ex :how do you feel?
How are things?
How do you feel teeth?
23. Open ended question
Advantages:
Allow patients to use their own words and summarize
their view of the problem.
Allow patients to partly direct the history taking, gives
them confidence and quickly generates rapport.
Disadvantages:
Clinicians must listen carefully and avoid interruptions
to extract the relevant information.
Patients tend to decide what information is relevant.
24. Close end question
May require only yes or no answer
Ex:
Do you have heart problem?
Do you smoke?
25. Closed questions
Advantages:
Elicits specific information quickly .
Useful to fill gaps in the information given in response
to open question .
Prevents vague patients from rambling away from the
complaint.
26. Closed question
Disadvantages:
Patients may infer that the clinician is not really
interested in their problem.
Important information may be lost if not specially
requested.
Restricts the patients opportunities to talk.
29. Assisting the patient’s narrative
Specific interviewing techniques:
1. Developing rapport
2. Keeping your distance
3. Facilitation
4. Interpretation
30. 1-Developing rapport
Rapport is a state of mutual interest and respect that
allows for direct and open communication
To develop it dentist should be
Supportive by showing interest and concern
Should be reassuring and show empathy
Patient’s feeling should be respected
Should not criticize patient in any way
Assisting the patient’s narrative
31. 2-Keeping your distance
It should be done in the dental operatory
Dentist and patient should be seated upright and in
full view of one another
Should not take place in an area where other patients
are present
Should be conducted by the dentist himself not by an
ancillary personnel
Assisting the patient’s narrative
32. 3-Facilitation:
It is a verbal or nonverbal gesture made to encourage
the patient to continue talking
It may be a phrase worded to help patient’s flow of
thought.
Assisting the patient’s narrative
35. Touch
The value of this activity varies and depends upon:
How the contact is made
The sex of the individuals
The age differential
The timing of the action
( A reassuring hand on the shoulder is
better premedication than 100 mg
barbiturate)
36. Body Language
Individual moods such as
sadness, anxiety, happiness, and others are more
properly called affectual states.
Bode language in the form of gestures and posture
often indicates these affectures states.
37. Body Language
Depression can be produced by life
circumstances, physical ailments, and drugs.
A depressed patient may be difficult to manage, and
conversion of the depression into dental symptoms may
occur.
Anger and hostility are reactions to sickness in some
people, and the dentist may become the target of these
feelings.
Anxiety is an unpleasant affectual state that may be caused
by a real or an imagined threat.
Sometimes receptivity to new ideas can be judged by the
patient's body language.
38. Dress and Personal Hygiene
Dress and personal hygiene communicate something
about how the patient would like others to relate to
him or her.
39. Interviewing errors and pitfalls
1. Suggestive Questions
2. Why Questions
3. Multiple Questions
4. Questions answered by yes or no
5. Patient’s Questions
6. Hasty reassurance and early opinion
7. Use of jargon
8. Assuming patients’ understanding
9. Use of emotionally neutral word
40. 1-Suggestive Questions
Gives the answer in the phrasing of the question.
May not suggest an exact answer but could narrow the
field of answer.
Interviewing errors and pitfalls
41. 2-"Why" Questions
Generally it shouldn’t be asked by the interviewer
Ex:
why don’t you brush your teeth?
When asked the patient feels threatened
Interviewing errors and pitfalls
42. 3-Multiple Questions
Multiple rapidly fired questions are rarely helpful
Exception:
With uncommunicative people, they help them to
begin answering
Ex: when did the pain begin?, what makes pain
relief?, does anything make it worse?
Disadvantage: they may be confusing
Interviewing errors and pitfalls
43. 4-Questions Answered by Yes No
It gives no details
When obtained, one should ask follow-up and check
questions.
Interviewing errors and pitfalls
44. 5-Patients' Questions
Generally the dentist does not have adequate
information to answer questions on the future care of
the patient during the interview
Should be at the appropriate time
Personal questions should be answered only if they
will not harm the professional relationship.
It may be a signal that the patient wishes to change the
topic
Interviewing errors and pitfalls
45. 6-Hasty Reassurance and Early Opinions
Rapid and early response should be avoided until
everything has been gathered and a diagnosis has been
made.
Dentist should give note that opinion will be given at
the earliest appropriate time
Interviewing errors and pitfalls
46. 7-Use of Jargon
The use of professional jargon leads to
misunderstanding and confusion
Interviewing errors and pitfalls
47. 8-Assuming Patients' Understanding
Dentist should ensure that the patient understand what
is said specifically in relation to dentist’s instructions
Interviewing errors and pitfalls
48. 9-Use of Emotionally Neutral Words
In choosing words, efforts should be directed toward
keeping the patient's environment pleasant by using
phrases that are mild and do not conjure up
undesirable images.
Interviewing errors and pitfalls
49. References
Steven L. Bricker, Robert P. Langlais, Craig S. Miller.
Oral Diagnosis, Oral Medicine, and Treatment
Planning, second edition, BC Decker Inc.2002
Greenberg MS, Glick M. Burkett's Oral Medicine&
Diagnoses, 11th ed., Philadelphia P.C Decker.
Inc.2008 page 5