Your actions and utterances profoundly influence your patient’s replies

• How we ask questions affects the quality and quantity of information received
• By the nature of our (closed) questions, we impose limits to our patient’s freedom to elaborate

Appropriately move from open to closed interviewing

• Open (divergent):
  • Introduce an area of enquiry without unduly focusing the content of the response
  • Still direct your patient, but allow the patient more discretion in their answer while suggesting that elaboration is welcome
• ‘Tell me about your headaches’
• Closed (convergent):
  • Specific, often one-word answers are elicited
  • Limit the response to a narrow field
• ‘Do you ever wake up with headaches in the morning?’

 The Open-to-Closed Cone

• Starting with open techniques and moving to closed questions later on
  • Initially, open techniques: obtain a picture of the problem from your patient’s perspective
  • Increasingly specific, though still open
  • Closed questions: elicit additional details
• Experienced practitioners utilize multiple open-to-closed cones throughout the interview

The Advantages of Open Questioning Techniques

1. Encourage your patient to tell their story in a more complete fashion
2. Allow you time and space to listen and think (not just prepare the next question)
3. Contribute to more effective diagnostic reasoning
   • Reduces “tunnel vision” and premature narrowing of enquiry
4. Aid in the exploration of both the disease and illness frameworks
5. Allow for increased patient participation (rather than physician domination)

Exercise: Using open-ended questions allows your patient freedom in telling their narrative. How might you handle a patient who cannot remain focused on the narrative and often becomes side-tracked?

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients (Thrid Edit). London: Radcliffe Publishing.