Patient Interviews: The Heart of the Exam

We've all been there before. It's a busy weekday morning, and everybody's moving fast. An elderly house patient arrives in the radiology department on a stretcher. Joe, a staff radiologic technologist, walks over to the woman, looks at her wristband and says, "Good morning, Mrs. Smith. I'm Joe Adams,

Mrs. Smith stares unblinkingly at the ceiling, her only reply an unintelligible "Nhaaa, nhaaa."

It may seem like little information was exchanged during this conversation, but Joe actually has learned a great deal from this "interview" of Mrs. Smith. He now has a better idea of how to proceed with the exam. He knows approximately how much cooperation he can expect from the patient. And, Joe knows that he should tell Mrs. Smith about what is happening during the exam, just in case she can hear him. After all, talking patients through exams is what Joe does all day.

The Role of Patient Interviews

As students, we're taught how to read patient charts. We're taught about the illnesses and injuries we are likely to encounter in the radiology department and how they manifest themselves. We're taught the mechanics of performing various diagnostic imaging exams. Interviewing skills, however, can't be taught in the classroom. We must learn interviewing through observation and trial-and-error. There are no classes or practice sessions.

When you were a radiography student, you spent your clinical time watching the radiologic technologists greet patients, listening to them answer questions, paying attention to how they explained the procedure. You stood in the corner, listening to the conversation about Mr. Craig's pancreas or Mrs. Anderson's gallbladder. You observed and, hopefully, absorbed.

Then one day, it was just you and a stranger whose name you couldn't pronounce. You lurched into your interview as best you could, and eventually you got good at it. In fact, all of us are probably much better at interviewing than we realize, even though we don't think of ourselves as "interviewers." We ignore this important facet of patient interaction, thinking of ourselves solely as professionals trying to perform diagnostic procedures as smoothly and quickly as possible.

But think about how much time you spend talking to each patient, how many questions you ask and how much explaining you do. It's probably safe to say that for most of us, the entire exam consists of an extended patient interview, with pauses in between for technical procedures.

What Is an Interview.

Most radiologic technologists do not picture themselves as interviewers, even though interviewing is a big part of our jobs every day. That's because when most people hear the word "interview," they think of a formal job interview. Actually, an interview is any type of planned communication between two parties that involves the asking and answering of questions. There are many types of interviews, including surveys and opinion forms.

The kind of interview we conduct with our patients is called an informational interview. Its purpose is to get and g*e information. Some type of information exchange must take place between a patient and a health care professional before any medical exam begins.

The two parties also must establish their relationship, with the medical professional taking the role of the interviewer and the patient (or a family member) as the interviewer. The two parties maintain these roles most of the time. But occasionally, the patient will be the one asking questions. This turn-about is known as an interchanging of roles, and a good interviewer will allow this interchange to occur more than once during an interview and even will encourage a patient to ask questions and voice concerns.

The Interview Process

Every interview has three parts -- an opening, a body and a closing. During the opening, introductions occur and a rapport is established. Rapport, defined as "a relationship characterized by harmony," is essential to any patient-technologist communication. Without rapport, the exam will be difficult or, at best, unpleasant for both parties. In fact, if an adequate rapport is not established, the exam sometimes cannot take place at all. The interviewer either gains or loses the patient's trust during the opening phase of the interview. Most of the time, both patient and radiologic technologist succeed in establishing a pleasant relationship.

During the body of the interview, the radiologic technologist explains the procedure to the patient and answers questions. Also, the technologist may have questions of his or her own about allergies, previous exams or medications that must be answered before the procedure can begin. Questions continue to be asked and answered by both parties during the procedure itself. Relevant issues are explored and instructions are given. The parties often digress and chat.

The final phase of the interview is the closing. After the exam is finished, the patient is given the opportunity to ask final questions or make requests. The radiologic technologist gives follow-up instructions, responds to any concerns and then wishes the patient well. The interview -- and the exam -- are over.

Interpersonal Dynamics

During an interview, the relationship between the patient and the radiologic technologist is clearly defined. Each must play their assigned roles, establish a rapport and exchange information. Only by working as a team can they obtain the necessary diagnostic images. Communications theorists call this aspect of the interview process "relational dimensions."

The relational dimensions of any interview can be broken down into three aspects -- control, inclusion and affection.

* Establishing the proper level of control is an important aspect of the interview. Because the radiologic technologist controls the diagnostic procedure, there always will be a power imbalance between the two participants, with the patient on the short end. But the technologist can work to ensure that the level of control does not make the patient uncomfortable. Control seems to work best when it is as tight as it has to be and as loose as it can be. Although the radiologic technologist tells the patient what to do, when to do it and how to do it, the patient always should be treated like an equal. If the technologist doesn't make the patient feel comfortable and safe, the patient is likely to rebel or resist. The balance between friendliness and professional distance has to be varied with each patient. Most technologists succeed, having learned through trial-and-error how to judge a patient.

* "Inclusion" explains everyone's reasons for participating in the relationship. For the radiologic technologist, those reasons may be based on career choice, job description and the promise of a paycheck. For the patient, inclusion factors may be the pain in his shoulder or his physician's insistence. The inclusion factors must be strong enough to see both parties through the exam. These factors also influence how willing each will be to work with the other. For example, a patient may know he needs diagnosis and treatment, yet have such a strong aversion to hospitals that he is unwilling to proceed once he gets to the radiology department. Another patient may go through the preparations smoothly, but refuse to allow the radiologic technologist to administer an injection. Inclusion factors come into the exam room with the patient and the technologist.

* Affection is the third aspect of interpersonal dynamics. It can be defined as the attitude of the parties toward one another. In most cases, affection develops during the course of the exam. We hit it off with some patients right away, while with others it takes a little work. When there is a high degree of affection between the technologist and patient, both are willing to put forth greater effort for one another.

Conclusion

The interview is an integral part of the diagnostic imaging process. Through interviews, radiologic technologists educate their patients, establish a rapport and gain vital information that helps them perform quality examinations.

Most radiologic technologists conduct interviews by instinct, based on the feel of the interaction and by learning from previous experience. Even without any formal education in how to conduct interviews, we succeed at them all day long.

J.H. Batten, R.T. (R), worked in mammography and diagnostic x-ray for 19 years befoe quitting to return to college. She resides in Vancouver, Wash., and recently completed a professional writing program at Portland State University.

Radiologic technologists are invited to share their technical advice with other readers through this column. For details on how to submit a paper to the "On the Job" column, write to Managing Editor Ceela McElveny, c/o the American Socitty of Radiologic Technologists, 15000 Central Ave. SE, Albuquerque, NM 87123-3917.