Objectives: effectively closing the patient interview…

1. Summarizes and confirms your established plan of care
2. Clarifies the next steps for you and your patient
3. Maximizes your patient’s adherence, satisfaction, and health outcomes
4. Ensures efficient use of time in the consultation
5. Is a collaborative process and continues to build the doctor-patient relationship

Exercise: Before moving on, what do you think are common issues that arise as the interview is coming to a close?

What can go wrong when ending the interview?

• Patient introduces another major item:
  • Their ‘hidden agenda’; usually emotionally charged or psychosocial issues
• Patient demonstrates they have poor understanding of information thus far:
  • Usually by asking a question showing they have little understanding of the consultation to this point

Why does this happen? Difficulties with interview closure often result from…

• Communication issues earlier in the interview
  • Can be avoided by careful attention to patient-centred communication throughout the interview
• Not applying appropriate strategies during the closure itself
  • The focus of this chapter

Strategies to employ EARLIER in the interview:

To increase patient comprehension and decrease incidences of patients revealing major items late in the interview.

• Beginning
  • Attentive listening
  • Screening
  • Agenda setting

• Information gathering
  • Signposting
  • Exploring your patient’s ideas and concerns
  • Addressing your patient’s feelings, thoughts, and emotions
  • Discussing psychosocial issues

• Explanation and Planning
  • Information giving
  • Involving your patient in explanation and planning
  • Checking for your patient’s understanding
  • Asking your patient if they have questions

Exercise: Before moving on, what are the pros and cons of:

1. Using close-ended statements to quickly end a consultation
2. Using open-ended statements allowing for patient feedback

Continue empathic, patient-centered communication!

• Tension exists between efficiency and completeness
• (1) asking open questions, (2) showing concern or responsiveness, and (3) laughing and displaying emotion, have all been shown to increase closure time; but allows proper empathy and exploration of the patient’s illness perspective
• Attempting to quickly end the interview with closed questions may actually decrease immediate and long-term efficiency
• Differing patient and physician agendas hinder communication immediately and affect the long-term doctor-patient relationship