A 62-year-old man comes to the office with his wife for evaluation of episodic chest pain. The physician introduces herself to the patient and his wife and confirms that he is comfortable and not experiencing any current pain. The patient's wife begins the conversation by saying, "He brought a list of his medications for you to review, but I'm not sure he takes all of them regularly." After thanking them for bringing the list, which of the following is the most appropriate way for the physician to initiate the medical interview?

Question

A 62-year-old man comes to the office with his wife for evaluation of episodic chest pain.  The physician introduces herself to the patient and his wife and confirms that he is comfortable and not experiencing any current pain.  The patient's wife begins the conversation by saying, "He brought a list of his medications for you to review, but I'm not sure he takes all of them regularly."  After thanking them for bringing the list, which of the following is the most appropriate way for the physician to initiate the medical interview?

Quizplus · Accepted Answer

Patient-centered care requires communication skills that engage the patient in discussing his or her perspective of the illness, which helps build rapport and aids in acquiring a more complete history. In this scenario, the wife begins the conversation by expressing her concern about the patient's medication adherence. Although acquiring collateral information can be important, the best approach is to redirect the conversation back to the patient to first elicit his perspective and concerns. It is better to explore medication adherence once rapport has already been established. Medical interviewing is best initiated with an open-ended question. This invites the patient to describe their condition in their own words and gives the physician insight into the patient's major concerns, which can be addressed with more specific questions later in the interview. Examples of open-ended questions include: "What brings you in today?" and "What is that like for you?" In contrast, a closed-ended question requires only a yes/no response and does not encourage conversation/exploration. (Choices A, B, and E) Although the wife has alerted the physician to a potentially important issue (possible medication nonadherence), it would be inappropriate to begin a medical interview with questions that assume (without asking) that the patient is, in fact, not taking his medication and focus on the wife's concerns rather than the patient's. This may put the patient on the defensive, leading to a deterioration of the physician-patient relationship. In addition, asking the patient if he is having trouble with remembering his medications is an example of a yes/no, closed-ended question. (Choice C) Although patients should be given the opportunity to speak to the physician alone, this question suggests the wife should leave. It is preferable to ask the patient if he would like her to stay or leave. Educational objective: Patient-centered medical interviewing should focus on the patient's perspective of the illness. Interviews are best initiated with an open-ended question that elicits the patient's major concerns in the patient's own words. __________ References: Patient-centered communication: basic skills. (http://www.ncbi.nlm.nih.gov/pubmed/28075109)

A 62-Year-Old Man Comes to the Office with His Wife