Introduction

The professional skill of being able to appropriately plan and conduct an assessment interview has long been recognised as a key factor in successful clinical assessment (Dickson et al 1997). Indeed, it has been argued that communication skills of healthcare professionals are at least as important as their clinical skills in fulfilling the professional role (Alexander 2001). The significance of successful communication in healthcare has also been reflected in government policy, with the need to improve such skills identified as a key area for education and training in The NHS plan (Department of Health 2000). A key part of communicating successfully in a healthcare setting is having the ability to conduct a satisfactory assessment interview. This chapter focuses on the purpose of the interview, the skills required to communicate effectively, explore how the interview should be structured and identify the pitfalls to avoid. It concludes by examining the features of a good assessment interview.

Is an interview different from a normal conversation?

An interview is based on a conversation between two or more people. As individuals we converse with a broad range of people, and our conversation serves many purposes. The conversation in an interview differs from an ordinary conversation in several ways:

• It is an opportunity for an exchange of information.

• It has a specific purpose, e.g. to solve a problem.

• It has an outcome, e.g. a course of treatment.

• It has less flexibility than an ordinary conversation.

• The interviewer has a perceived position of authority/power over the interviewee; it is important that this power is not abused. Every effort should be made to put the interviewee (the patient) at ease.

• A written record of the interview is usually kept.

Practitioners may also have other types of conversation with patients, requiring additional skills such as counselling, teaching and advising. These are discussed in the companion textbook, Clinical skills in treating the foot (2nd edition, Elsevier Churchill Livingstone, 2005).

Aims of the assessment interview

The assessment interview is a conversation with a purpose that takes place between the practitioner and the patient. Patients present with problems which may have physical, psychological and social dimensions. Patients often have their own ideas and concerns about the problems they present with, and about the medical care that they may or may not receive. Likewise, practitioners approach the interview with perceptions of their role, which will have been influenced by their training, past experiences, attitudes and beliefs. The availability of resources and facilities will contribute to the practitioner’s response to the patient. It is essential that the practitioner and the patient develop common ground during the interview and that both are aware of each other’s perspectives. If this cannot be achieved, the interview may be an unsatisfactory experience for both of them.

The prime purpose of the interview is to identify the cause of the patient’s concerns and the appropriate actions to be taken. This is best achieved by the patient and the practitioner working in partnership to reduce or resolve these concerns. It is essential that practitioners provide ample opportunity for patients to convey their concerns and worries. In other words, the interview should be patient-centred. Research has shown that this is not always the case and despite the time afforded to clinical interviews, many are conducted rather poorly (Newell 1994).

Information gathered collectively from the interview and examination should facilitate the identification of the patient’s health problem and, where appropriate, a diagnosis can be made. Besides aiding the diagnostic process, the interview serves other important purposes:

• The information gained may be of help when drawing up a treatment plan. For example, the interview can provide a picture of the patient’s social circumstances, which may affect the manner of, or the actual, advice given.

• It provides an opportunity to gain the patient’s trust and build confidence in the practitioner.

• It facilitates the development of a therapeutic relationship between the healthcare practitioner and the patient.

However, not all healthcare students are aware of how to communicate effectively and, as a result, communication skills training is becoming a common part of the curriculum of healthcare courses (Hargie et al 1998, Sleight 1995).

Communicating effectively

Since the interview has a particularly significant role in the assessment of the patient, it is important to ensure that the meeting is successful. In other words, good communication skills are essential if you are to achieve an effective assessment interview. What is meant by communication? In its simplest form it can be seen as the transmission of information from one person and the receiving of information by another. Unfortunately, the communication process is not that simple; if it was, there would not be communication breakdowns or misunderstandings between people about what was said.

Communication may be influenced by certain characteristics of:

• the sender (e.g. ability to express ideas clearly, verbal skills, attitude towards the patient)

• the receiver (e.g. the extent to which the receiver is paying attention, their ability to hear and understand the conversation, and their beliefs and expectations)

• the social environment in which the interview is being conducted (e.g. disruption due to background noise).

With so many opportunities for these forms of interference, it is not surprising that many attempts to communicate effectively fail. Consequently, healthcare professionals should develop their communication skills to make the best use of the interview.

A common question asked is: ‘Are some people born with good communication skills or is it a skill you can learn?’. The answer has to be that it is a combination of the two. We can all think of people we consider to be good communicators; these people appear to have an inherent skill. For others, communication may not come so easily. It is particularly important for health practitioners to be aware of and develop effective communication skills because so much clinical information is gathered through the assessment interview. Research has shown that clinical communication and relationship skills can be developed strategically through education and training (Stein et al 2005), and that good communication can be an effective intervention in longer-term patient care (Trummer et al 2006).

A myriad of books are available on the subject of communication skills. However, just reading a book does not automatically mean you become a good communicator. Observing others, noting good and bad points, receiving feedback from others, role-play exercises, videotaping and audiotaping of interactions, and practising with friends are all helpful ways in which such skills can be developed. Being an effective communicator is a skill – and like any clinical skill it should be regularly practised and reviewed.

Although you may not be able to change the communication characteristics of the patient or the social environment, you can ensure that your contribution to the interview is as effective as possible. You can do this by sending clear and appropriate messages to the patient and by ensuring that you understand fully what the patient is trying to communicate to you. To achieve this, you need to pay careful attention to three key components of the communication process:

• Questioning skills

• Listening skills

• Non-verbal communication skills.

Each of these skills will be considered in turn below.

Questioning skills

The prime purpose of the assessment interview is to gain as much information as possible from the patient so that a diagnosis and treatment plan can be determined. To achieve this objective, the practitioner uses a range of questioning skills. There are three categories of question:

• Open

• Closed

• Leading.

• Show empathy. Authier (1986) defined empathy as being ‘attuned to the way another person is feeling and conveying that understanding in a language he/she understands’.