Fifth Edition (2006)

John Coulehan and Marian Block

F.A. Davis Company, 409 pages

Overall rating: Sadly flawed

Strengths: Offers a good breadth of practical skills to apply to the medical interview

Weakness: Uses clinician to clinician communication as a basis of understanding patient to clinician communication

Audience: Junior Medical Learners

The Medical Interview is a commonly used book for teaching junior medical learners the basic methods of interviewing patients.  It contains a wide variety of well explained skills in regards to variety of aspects of communication with patients.  It has good advice in regards to adolescents, geriatrics, cultural competence and breaking bad news. In particular, its descriptions of the empathic cycle and empathic levels of responding are excellent.  Categorizing responses as ignoring, minimizing, interchangeable and additive gives learners a comprehensible framework of how to respond to patients’ feelings and emotions rather than with rote statements such as “I’m sorry,” or “that must be very difficult.”

Despite the plethora of excellent content contained within The Medical Interview, Coulehan and Block make the same tragic mistake of organizing the interview based clinician to clinician communication rather than clinician to patient communication.  The major sections of the text are components of the case report which gives the mistaken impression that medical interviews should flow based on that paradigm rather than the freer flowing and messier interaction that patient centred interviewing requires.  I worry that following this text would make learners’ interviews far more rigid as they try to keep with this set structure.  This book is also challenging to use from a curricular perspective.  There is no attempt to provide a bird’s eye model of communication that can be easily remembered and diagrammed.  Its content, while organized, is not layered in a way to facilitate recall.

I think the numerous ideas contained within The Medical Interview has value as a reference text but not as the framework to understand the medical interview.  I would discourage learners from using this as a structure to understand how to communicate with patients as its methods can potentially lead to the flawed communication style frequently seen within health care.  I believe undergraduate medical curricula are better served by utilizing other texts.