When you come into the room and introduce yourself, repeat the patient’s name, and be sure to establish eye contact—all of which initiates the development of rapport.
Your first question should be, “What brings you in to see me?” After their reply, you should state the goals for their visit that incorporate their symptomatology: “We need to determine your diagnosis and decide what is the best way to evaluate and manage your care.”
You next explain that you would like to begin by asking two sets of questions. These questions provide insight into the patient’s perception of their problems, how they are managing them and their previous healthcare experiences.
The first question you should ask is: “Who is in charge of your care?” More than 50% of patients answer, “Doctor, you are.” Other possible answers include “I am” and “My [significant other] is.”
For your reply, you use the analogy that they are the “captain of the ship,” their significant others are their “first mates,” and their healthcare professionals are the “navigators” of their care. This point is then further emphasized by saying, “You are the one steering the boat, and if you are not sure who is in charge and where you are going, you are not likely to get there.”
Now that the patient’s and others’ roles have been defined and, hopefully, established, the next set of questions is intended to explore the patient’s perceptions of their pain symptomatology. The next question is: “Is your pain real?” The patient’s response is almost always “Yes.”
Because of the nature of the next question, it is useful to begin with an explanation to the patient, “The next question can be sensitive. Do you think that I believe that your pain is real?”
There are three general answers to this question: “Yes, you do,” “No, you don’t,” and “I hope so.” Over 90% of patients answer “I hope so.”
When an individual answers, “No, you don’t,” the response signals a potentially difficult patient and should be followed up with the question, “Why do you feel that way?”
The last question of this set is, “Do you want to have your pain?” The patient’s response is almost universally “No.”
To conclude this initial segment of your interview, summarize by saying, “You are in charge of your care, and I am your navigator. Your pain is real. I believe you, and you don’t want to have pain. Help me help you.”
Remember that the evaluation [during the first visit] is not only yours of the patient, but also their evaluation of you, which can have a profound & lasting impact on the success of your relationship.
Positive Approach Cemented
This initial interaction and line of questions takes between two and three minutes. It explores and validates the patient’s perception of their illness and defines your engagement with them.
