Abstract
In clinical diagnosis and physical examination, the inquiry process is crucial. I know you are an expert, but extracting information from patients is not always an easy task. However, a higher quality inquiry requires attention to methods and techniques. What situations in inquiry are the most challenging? What details should be noted?
Grasping the Timing and Progress of Inquiry
The inquiry time should be appropriate: generally not exceeding 40 minutes, but it should not be too brief, less than 10 minutes, except for critically ill patients. Hospitals with conditions often arrange appointments for patients, which means there is ample time for doctor-patient communication. When patients enter and sit down, the doctor or staff will offer a glass of water, allowing the patient to rest briefly. This is especially important for parents of children and the elderly. During this one or two minutes, the doctor can organize the inquiry questions in their mind based on the patient’s medical history, being clear about the purpose, process, and expected outcomes of the conversation. After resting, the patient’s thoughts will also be clearer.The doctor’s role in the inquiry is dominant. The doctor can trace the evolution of the patient’s symptoms in chronological order, which helps avoid missing important information. For example, the doctor might ask, “What happened next? And then…” If several symptoms appear simultaneously, it is also necessary to determine their order of occurrence.Moreover, the doctor needs to use transitional language to guide the patient in discussing different issues. For instance, “We have been discussing the purpose of your visit today; now I would like to understand your past medical history, tracing back to your childhood”; “How was your health as a child?” Using such transitional language helps the patient understand why the topic is changing and why these questions are being asked.The purpose of the doctor’s inquiry is to gather more information from the patient, but it is crucial to avoid hastily asking a series of questions that leave the patient no time to consider their answers. Listening is as important as asking questions. The doctor should not interrupt the patient easily and should allow enough time for the patient to answer questions, as well as permit pauses for thought.If the patient keeps discussing many unrelated issues, the doctor can politely guide the patient back to the medical history, such as saying, “I understand your concerns; now please tell me about your chest pain situation!”
Open-Ended Questions or Closed Questions?
Open-ended questions are beneficial for the doctor to gather a wealth of information about a specific aspect of the patient. This type of questioning allows the patient to narrate their condition like telling a story. For example, “What discomfort do you have today?” or “Please tell me about your general health status.” Such questions are often used at the beginning of the inquiry. After obtaining some information, the doctor can then ask more specific questions. Starting with direct or selective questions may limit the patient’s ability to communicate, making it difficult to obtain necessary information.Once the doctor has grasped the patient’s basic information and can use their experience to further assess the patient’s condition, they will often use closed questions. The doctor can purposefully and systematically ask specific questions, such as “How long have you had abdominal pain?” or “Is your pain sharp or dull?” This prompts specific information that is more targeted. To systematically and effectively obtain accurate information, doctors should generally follow a process from general to specific questioning.Sometimes, to verify information, the doctor may need to ask the same question multiple times, reiterating key points. However, unplanned repetitive questioning may damage the harmonious doctor-patient relationship and erode the patient’s trust. To prevent omissions and forgetfulness, the doctor should comprehensively and focus on summarizing each statement made by the patient. At the end of the inquiry, the doctor can also summarize key points for the patient to hear, checking if the patient has any additions or corrections, which will help reduce repetitive questioning.
Choosing Appropriate Language
Language is a tool. People can use this tool to express their thoughts. We cannot perfectly convey our thoughts to others, but we can at least avoid using vocabulary and tone that lead to ambiguity and misunderstanding.When communicating with patients during inquiry, doctors should strive to use language that is simple and easy to understand, avoiding medical jargon. For instance, when inquiring about a heart disease patient, one might ask, “Do you experience sudden awakenings due to shortness of breath at night?” instead of asking, “Do you have paroxysmal nocturnal dyspnea?” It is also important to avoid using ambiguous medical terms such as “urgency with a feeling of heaviness,” “epistaxis,” “occult blood,” “delirium,” etc.Additionally, the tone of questioning is crucial. Sometimes, the tone of a rhetorical question can reinforce affirmation, but it is rarely used in everyday communication. Doctors should especially avoid using such tones in their inquiries. For example, “Don’t you feel that your sleep is disturbed?” This type of question can be misleading and may create psychological pressure on the patient.At the same time, doctors should avoid suggestive questioning. For instance, when asking a patient about abdominal pain, one should not directly ask, “Does the pain radiate to your right shoulder?” Instead, a better approach would be to ask, “Does the pain affect other areas?” This way, the medical history obtained is more objective and truthful.Doctors should also pay attention to patient privacy and other issues during the inquiry, ensuring that their voice is low and their language is gentle.
Honesty and Openness
Some patients may respond with “yes” to questions about unclear medical history; others may feel fear about their condition, potentially hiding the truth or exaggerating their symptoms, not being truthful, or even fabricating their condition. In such cases, doctors should analyze and judge with a scientific attitude, identifying unreliable or ambiguous areas, and ask repeatedly from different angles to obtain reliable medical history, avoiding subjective assumptions and hasty conclusions, and not casually informing patients of their diagnosis, while also not being overly skeptical of the patient.Doctors should also understand whether their knowledge level matches the patient’s needs. When they cannot provide sufficient information or appropriate medical advice, doctors should acknowledge their lack of experience. If a patient asks a question that the doctor does not understand, the doctor should admit it and immediately seek answers for the patient.
Encouraging Patient Questions
Outstanding speakers not only excel in language and logic but also win applause from the audience through their demeanor and interaction. During inquiry, it is crucial to give patients the opportunity to ask questions, as they often have doubts that need further explanation and may think of new questions they had not considered before. Doctors should clearly provide patients with the opportunity to ask questions or discuss issues. For example, doctors can inform patients that if they have questions or can provide more information related to the discussion, they should feel free to speak up, usually at the end of each main topic of conversation.Doctors should demonstrate their demeanor during the inquiry, allowing patients to feel fully cared for and respected.At the end of the inquiry, a closing statement should indicate the conclusion of the inquiry, clearly outlining the inquirer’s role and obligations; addressing the patient’s requests and hopes; and clearly stating the future treatment plan, including what both the inquirer and the patient need to do next, as well as scheduling the next appointment.
Inquiry is a special dialogue, and its effectiveness lies in the doctor’s foresight, logic, and demeanor. Regularly summarizing the inquiry dialogue helps improve the quality of doctor-patient communication.
Source: Mayo Clinic International
