Medical Interviewing and the Doctor-Patient Relationship
Tufts University School of Medicine
Introduction to Jewish Community Housing for the Elderly (JCHE)
For half of the interviews you will be doing in this course, you will be assigned to one of three sites at JCHE. The tenants have graciously agreed to contribute to your education by participating in these practice interviews. While they are not presently patients in a hospital, or even an outpatient setting, they all have rich stories and interactions with health care practitioners and systems that will help you understand them and their perceptions and needs in a doctor-patient relationship.
JCHE is independent housing that consists of six buildings in four locations for people over age 65. People need to live independently and accomplish ADLs (activities of daily living) by themselves in order to remain at JCHE. There are no medical personnel working on site at any of the buildings. There is a nurse for blood pressure checks and a podiatrist who visit on a weekly or bi-weekly basis for a few hours.
However, a contract with Springwell, a social service agency that provides assistance with ADLs or any other housekeeping needs on a private fee based schedule, does allow us to assist tenants where needed so that the tenant may age in place with dignity.
The average age of our residents is 82 years. Residents are American, Russian, and Chinese.
The experience you will have with JCHE residents is one that should ideally accomplish two major goals:
To engage in the practice of interviewing and history taking to hone your skills, practice the competencies you learn in the morning lecture, and understand older adults’ needs in relation to medical interactions. To do this you should ask questions directly related to the competency but also questions such as what was your last visit to the doctor for and was it satisfying or not; have you ever been hospitalized and how did you feel about the experience; do you have any health concerns and does your doctor address them to your satisfaction. With those questions tenants will have the opportunity to share with you their encounters with medical personnel which should be valuable knowledge.
To experience an intergenerational interaction with a segment of the population that you will see more frequently in your career as the demographics of our country rapidly changes and ages. This intergenerational interaction should be viewed as an opportunity to experience and value the rich wisdom and life lessons that older adults possess. To some degree we all carry with us stereotypes that often prevent us from seeing the inner person and the goal here is to experience, in even a short relationship, the beauty of that wisdom and the value that person has for, and in, society.
To understand more fully the role of intergenerational connections in changing stereotypes, and the reciprocal nature of those relationships, please read the attached two research articles and one fact sheet. They should help you recognize the importance of these relationships and perhaps change your mental approach to this course experience.
Erik Erikson identified this older adult stage of life as generativity and ego-integrity where the passing on of life lessons needs to happen in order to see one’s life as complete. In this youth-oriented, age-segregated society it becomes difficult for that to happen unless young people are willing to assist in that by listening and valuing elders. In this course you can make that difference by listening and providing the opportunity to be valued.
Your interview sessions should primarily consist of you asking the questions that will fulfill goal number one since that is a priority for you and the course requirement. Leave about 15 minutes at the end of your interview however, and ask the tenant to provide any advice, information, thoughts, or wisdom that will enlighten you in treating the elder population effectively. Finally, a hand written thank you note at the end of each session helps to validate the older adult as someone who has something important to offer.
The tenants are so eager to participate in this program that we often have to turn some away. They see it as a chance to help train future doctors and it becomes very important to them. Many of our Russian tenants in particular were physicians in the former Soviet Union and have no opportunity to practice medicine in the US. They especially feel this interaction with you is a way to give back and be effective leaders in the field of medicine. We hope you enjoy the experience and are able to view it from multiple perspectives. We are delighted to be a part of this course and your medical experience.
Helpful Tips for Interviewing at JCHE
Frame the Interview
When interviewing residents at JCHE, you will not be conducting the interview in a traditional healthcare setting, but within the resident’s home. The residents are typically not acutely sick and some may have very few health concerns. This setting does not lend itself as naturally to launching into a medical interview. Although the residents have been told the purpose of your visit, it is helpful to frame and provide a context for the interview before beginning.
“Hi my name is ______ and I am first year medical student. We will be practicing taking a medical history. I was wondering if we could start by telling me about the last time you went to the doctor. “
“Let me know if at any point you don’t want to answer my questions or feel uncomfortable. We are learning about taking a sexual history and there are a couple of questions that I would like to ask you.”
Other ways to start the interview:
Last time you went to the doctor, what was bothering you?
Do you have a primary care doctor? Do you have an upcoming visit?
For a talkative and off topic resident
In order to get the resident back on track, you may need to be a little more forceful in order to interrupt. Try saying:
“I am very interested in that and it sounds like it is very important to you, but I was wondering if you could answer_____(insert question)____.
“I understand what you are trying to say, but can you tell me a little more about _____(insert question)____.”