Ch12: Doctor-Patient Communication & Clinical Interview（医患沟通与临床访谈）

Preparatory Mindset

The doctor-patient relationship is the foundation of clinical practice. The lecture (13 Doctor-Patient relationship, image-only — 13 OCR pending) + the review docx cover clinical interview essentials, breaking bad news, doctor-patient communication skills, and the therapeutic alliance. The exam tests: clinical interview techniques (open-ended, closed-ended questions), empathy (Rogers' 3 conditions), breaking bad news (SPIKES), medical interview models, and adherence through communication.

Exam mindset: know Calgary-Cambridge or similar models (initiate → gather → discuss → close), SPIKES for breaking bad news (Setting, Perception, Invitation, Knowledge, Emotions, Strategy + Summary), Rogerian empathy statements, and the 4 functions of the medical interview (data gathering, rapport, education, adherence).

Core Concepts

1. Importance of doctor-patient communication (MUST KNOW)

• Affects diagnostic accuracy, treatment adherence, patient satisfaction, and health outcomes
• Associated with reduced malpractice risk, physician burnout, and patient complaints
• Active listening, empathy, and clarity are key

2. The medical interview — 4 functions

1. Data gathering (history, symptoms)
2. Rapport and relationship building (empathy, trust)
3. Information sharing and education (diagnosis, treatment)
4. Adherence and behavior change (motivational interviewing)

3. Clinical interview techniques (MUST KNOW)

• Open-ended questions: "Tell me about…" → invite narrative
• Closed-ended questions: clarification, specific facts
• Facilitation: "Go on," "Um-hmm"
• Reflection: echo the patient's words (simple) or meaning (complex)
• Clarification: "What do you mean by…?"
• Summarization: "So you've been having chest pain for 2 weeks, worse on exertion…"
• Empathic acknowledgment: "I can understand this has been difficult…"
• Silence: allows the patient to think and respond
• Direct questions: for specific data

4. Essentials and techniques for clinical interview (from review docx — MUST KNOW)

• Research the organization (chart, referral letter)
• Review the clinical concepts and procedures (be prepared)
• Practice behavioural interview questions (rehearse)
• Use direct questions (clarification)
• Open with "how does it make you feel" (emotional check-in)
• Closed-short answers should be said (be concise)

5. Calgary-Cambridge model (overview)

1. Initiating the session (introduce, establish rapport) 2. Gathering information (history, ICE — Ideas, Concerns, Expectations) 3. Physical examination (with consent) 4. Explanation and planning (diagnosis, treatment — check understanding) 5. Closing the session (summary, plan, follow-up)

• 5 stages:

6. Rogers' empathy in clinical practice

- "This has been a difficult time for you." - "I can hear that the pain has been overwhelming." - "Many people in your situation would feel…"

• Active listening — full attention, not interrupting
• Empathic acknowledgment — express understanding of the patient's emotions
• Examples of empathic statements:

7. Breaking bad news (SPIKES protocol — MUST KNOW)

• S — Setting: private, comfortable, no interruptions; turn off phone; offer support person
• P — Perception: ask what the patient already knows ("What have you been told about your condition?")
• I — Invitation: how much does the patient want to know? ("Would you like me to explain the details?")
• K — Knowledge: deliver the information in clear, jargon-free language; pause for response; "I wish I had better news…"
• E — Emotions: acknowledge and respond to emotions (silence, validate, "I can see this is difficult")
• S — Strategy & Summary: discuss the plan, next steps, support available

8. Difficult conversations

• Angry patients: listen, validate, set boundaries, avoid confrontation
• Emotional patients: silence, empathy, tissues
• Demanding patients: active listening, negotiate, set limits
• Non-compliant patients: explore reasons (side effects, cost, beliefs), use MI
• Difficult questions ("How long do I have?"): answer honestly, with empathy

9. Communication with families

• Confidentiality: the patient decides who knows
• Breaking bad news to relatives: same SPIKES; cultural sensitivity
• Family conferences: agenda, identify decision-maker, multidisciplinary team

10. Cultural and ethical considerations

• Cultural humility: open to learning from the patient about their culture
• Use professional interpreters (not family) for non-English speakers
• Informed consent: assess capacity, voluntariness, comprehension
• Confidentiality (with safety exceptions: harm to self/others, mandatory reporting)

11. The therapeutic alliance

• Bond (trust), Goal (agreement), Task (what needs to be done)
• The strongest predictor of therapeutic outcome (more than the specific technique)
• Develops early; can be repaired with apologies

12. Specific clinical scenarios

• Taking a sexual history: PLISSIT or 5Ps (Partners, Practices, Protection from STIs, Past history of STIs, Pregnancy intention)
• Talking about death: explore patient's understanding, acknowledge emotion, hope for the best
• Disclosing a medical error: apologize, explain, plan to prevent
• Handling requests for inappropriate treatment: explain politely, offer alternatives

High-Yield Points

• Calgary-Cambridge 5 stages: Initiating → Gathering → Examination → Explanation/Planning → Closing
• 4 functions of interview: data gathering, rapport, education, adherence
• Rogerian 3 conditions: empathy, unconditional positive regard, congruence
• SPIKES for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, Strategy+Summary
• Open-ended questions: "Tell me about…"
• Reflection: simple (echo) or complex (meaning)
• Empathic ack: "I can understand this has been difficult"
• Active listening: avoid interrupt, silence is OK
• ICE: Ideas, Concerns, Expectations
• Therapeutic alliance: bond + goal + task
• Cultural humility: use interpreters, explore patient culture
• Confidentiality: exceptions (harm to self/others, mandatory reporting)

Topic Summary

Doctor-patient communication is foundational to clinical practice — affecting diagnostic accuracy, adherence, satisfaction, and outcomes. The 4 functions of the medical interview are data gathering, rapport building, information sharing, and behavior change. The Calgary-Cambridge model has 5 stages: initiating (rapport), gathering information (open-ended questions, ICE — Ideas, Concerns, Expectations), physical examination, explanation and planning, and closing. Clinical interview techniques include open-ended questions, clarifications, reflection (simple/complex), empathic acknowledgment, and summarization. Breaking bad news uses the SPIKES protocol: Setting, Perception, Invitation, Knowledge, Emotions, Strategy + Summary. Carl Rogers' three core conditions (empathy, unconditional positive regard, congruence) underpin empathy in clinical practice. The therapeutic alliance (bond + goal + task) is the strongest predictor of outcome. Cultural humility, professional interpreters, and confidentiality (with safety exceptions) are essential. Specific skills include cultural sensitivity, taking a sexual history (5Ps), talking about death, and disclosing medical errors.