(Lesson 4-Table of Contents) (Next) (Glossary)

No one will deny that communication is an integral part of health care delivery. For this reason, a brief review of interviewing techniques has been included in this lesson.

There are two basic types of questions: leading and open-ended. Leading questions usually require a brief reply, such as "yes," "no," or "Friday." Leading questions are often used to obtain speedy factual information. However, they may cause you to miss significant or relevant information. Answering open-ended questions, on the other hand, requires a little thought and a sentence or two in reply. It provides no guidance as to the direction in which the patient should turn his thoughts and it may open up another line of questioning that you had not originally considered.

If you find you tend to ask leading questions, consider the following formula. Ask your patients "How do you feel about ____?" or "Tell me about ___." types of questions. Use short sentences and simple words. Ask only one question at a time and always pause to give the person you are visiting with time to respond.

When talking to patients or parents, always pay attention to what they say. Use reflective listening techniques and don't be in a hurry to correct misinformation. Patience is necessary when you are getting to know a patient or the family. Important clues may be missed or overlooked if you hurry through this process.

Some patients arrive feeling angry and blame others for their problems. Should this occur, allow your patient latitude to express these feelings. In such cases, it is best to simply acknowledge these feelings in a nonjudgmental manner. Do not rush to anyone's rescue or provide excuses for someone else's actions or behaviors. Knowing the basis of a patient's hostility should allow you to avoid or circumvent these pitfalls.

CONTENT OF DISCUSSION

Let your patients identify the matters which are to be discussed, especially when they are delicate or intimate. If you ask personal questions such as "Are you thinking about having more children?", take your cue from your patients. They may have been waiting for someone to ask and will talk on for an hour, or they may change the subject to avoid discussion. Their avoidance of a subject may alert you to other areas of concern. In this scenario, there may be marital difficulties that should be addressed that are of more importance than a discussion of genetics.

Nonverbal communication is an important part of any discussion or conversation. When talking to patients or parents observe their response to the things you are saying. Do your patients lean forward when engaged in conversation or do they shrink away from you? Are their arms crossed or do they reach out and examine the teaching tools you are using? All of these cues can alert you to your patients' underlying thoughts and feelings.

Don't forget that you are also communicating nonverbally with your patients. Your choice of seats in the room, the distance you put between yourself and your patient and your facial expressions and body language can significantly impact the patient-provider relationship. If you appear interested in your patient and actively listen, if you make an effort to present material in a way that can be easily understood, and if you respond in a nonjudgmental fashion both verbally and physically, you will promote a positive relationship.

When working with a couple assess their verbal and nonverbal interactions. Do both of them contribute information and ask questions? Do they appear tense in each other's company? Do they contradict one another? Are they sitting next to one another and offering support or are they sitting apart with their arms crossed? If you notice that one parent is not participating in the discussion, encourage participation by asking direct questions. Asking each person to describe their partner's response to their present predicament is another strategy to use if one person seems disinterested in the discussion or if there appears to be a current of underlying tension.

When referring a patient or family for a genetic evaluation it is also important to prepare them for the possibility of receiving ambiguous news. Patients often invest doctors with an aura of omniscience. As a result, when the news is ambiguous, they may find it difficult to comprehend. For instance, if a child is referred because of significant developmental delay, and the cause of the problem is unclear, a geneticist may be unable to provide the parents with a specific diagnosis or prognosis. In such cases, the parents may be puzzled by the referral and angry that they "wasted" their time and resources, or they may seize on the fact that an optimistic outcome is possible and speak as though it is assured. To avoid some of this confusion, patients should be told about the possibility of ambiguous results when the referral is made.

Lesson 4- Table of Contents) (Next) (Glossary)