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Watching the interview portion of a truly gifted doc or medic doing an H&P can be a thing of beauty, with a single perfectly-worded question gathering so much more relevant information than I would have gotten in five questions.  This has gotten me thinking about patient interview techniques, which really got short shrift in my paramedic program (and I don’t know that it’s improved much since then); particularly, I’m thinking about questions I’ve learned to avoid that I wish I would have learned about way back when.

For example, a typical question to ask is:  “Do you have any chest pain?”  After the first few times of a patient telling me:  “No, but it does feel like someone’s sitting on my chest,” I realized that I might be missing people who didn’t think of their chest pressure as pain per se.  “Do you have any discomfort in your chest?” has gotten so many more positive responses, people who may not have been treated for cardiac symptoms otherwise.  Similarly, “How is your breathing?” is frequently better than “Are you having any trouble breathing?”

Probably the worst question to ask, however, is usually asked at about 3 AM, and goes something like this:  “You’ve had this symptom for x hours/days/months, why did you call us now?”  I don’t know of any faster way to make a patient clam up, which leads to missed diagnoses, which can be very bad for the patient, and potentially open you up to legal trouble should things go south (no matter how good it may feel at the moment to vent your frustration).  The slickest trick I’ve ever learned (and, embarassingly, I can’t even credit the source) is to ask something along the lines of:  “You’ve had this symptom for x amount of time; did something change, or did you just get to the point where you just can’t take it any more?”  In a single sentence, not only can you keep the patient from becoming antagonistic, you can immediately decide whether the patient is someone who isn’t going to die, or is someone you need to dig a little deeper into.