Listen, look, and learn Much of what you need to know about any individual patient can be obtained by watching them enter the operatory and sit in the chair, observing their body language during the interview, and asking a few well-chosen questions. One of the great secrets to providing good health care is developing the ability to actually listen to what your patients tell you and to use that information. Doctors and dentists are often concerned that if they allow patients to speak rather than answer questions, history taking will be inefficient and time consuming. In fact, most patients will give the information necessary to make an initial diagnosis along with other useful information, if given the opportunity. Most will lapse into silence after 2–3 minutes of monologue. History taking should be conducted with the patient sitting comfortably; this rarely equates with supine! In order to produce a complete history, however, it is customary and often necessary to resort to directed questioning; here are a few hints: Always introduce yourself to the patient and any accompanying person and explain, if it is not immediately obvious, what your role is in helping them. Introduce your dental assistant as well. Remember that patients are (usually) neither medically nor dentally trained, so use plain speech without speaking down to them. Questions are a key part of history taking, and the manner in which they are asked can lead to either a quick diagnosis and a trusting patient or to confusion. Leading questions should be avoided for the most part, as they convey a preconceived idea to the patient. This is also a problem when the question suggests the answer, e.g., “Is the pain worse when you drink hot drinks?” To avoid this situation, use open-ended questions that require a descriptive reply rather than a straight yes or no answer. However, with an uncommunicative patient, it may be necessary to ask leading questions to elicit relevant information. Occasionally it may be necessary to interrupt patients during a detailed monologue on an irrelevant topic, such as their grandmother’s sick parrot. Try to do this tactfully, e.g., “How have things been in the last couple of days?” or “This is rather difficult—please slow down and let me understand how this affects the problem you’ve come to see me about today.” Specifics of a medical or dental history are described on see section and see section. The objective is to elicit sufficient information to make an initial diagnosis while establishing rapport. This will help to facilitate further discussion and/or treatment.
Posted on: Mon, 10 Jun 2013 12:20:39 +0000
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