The Medical Interview: Mastering Skills for Clinical Practice. (Book Reviews).

The Medical Interview: Mastering Skills for Clinical Practice. Fourth Edition.

Authors: John L. Coulehan and Marian R. Block.

Publisher: F. A. Davis Co., 2001

"If you would converse with me,

you must first define your terms."

Voltaire

The medical history is probably the most important part of the interaction between clinician and patient. Taking a good medical history is both a science and an art. It is a science because it is essentially based on the history that diagnostic and therapeutic strategies are developed. It is an art, because it is often difficult to reconcile what the patient really means, what he/she says, and what the clinician believes is the patient's real complaint and medical problem.

Taking a good medical history is a very skillful exercise because it has to be accomplished in a relatively short period of time, and because it often involves discussing with the patient personal and sensitive issues with which the patient may feel ill at ease. The clinician must rapidly sieve through a great deal of information, sort out what is important from what is not, pursue important leads, zoom in on crucial issues, and keep the interaction focused--a most difficult task.

The knowledge base of medicine has increased so much over the past few decades, and the curriculum is so overloaded that little time is devoted to teaching students and residents how to take a good history. Few students have more than a fleeting opportunity of observing a seasoned clinician interview a patient. A commonly held belief is that the skills of the "apprentice" will sharpen with time. Unfortunately the reverse is often true, and at least one study suggests that the interviewing skills of students actually decline as they progress through their training. Rather than maturing gracefully, the history-taking skills of the student regrettably often degenerate grotesquely.

In the fourth edition of the book entitled The Medical Interview: Mastering Skills for Clinical Practice, Drs. Coulehan and Block teach readers how to take a good history and how to establish a good rapport with the patient. The method they use is very effective. First, they discuss the basic issues about a particular aspect of history taking, then they illustrate their point by "showing" a live interview with a patient, and then discuss further issues raised during that interview. In addition, a summary is included at the end of each chapter to crystallize the various points made in that chapter. Finally, key points in each chapter are prominently listed to allow readers to refer to them with ease. References and suggested readings are also included at the end of each chapter.

The 296-page book is divided into three sections. The first section reviews the basic skills: understanding the patient's story, interpretation versus observation, precision, sensitivity, specificity, and reliability (Chapter 1), respect, genuineness, empathy, levels of responding, using words to identify symptoms and feelings, and nonverbal communication (Chapter 2), the chief complaint and present illness (Chapter 3), other active problems, the past medical history, and the family history (Chapter 4), the patient's profile, including demographics and occupational history, life-style, spirituality and beliefs, relationships, and sexual history (Chapter 5), the review of systems, transition to the physical examination, conversation during the physical examination, and ending the interview (Chapter 6). At the end of this section a special chapter (7) is devoted to the clinical narrative, how to present the patient and how to communicate with other professionals, such as requesting and providing a consultation.

The second section discusses the basic skills in practice: special patients and settings. This section discusses special issues concerning the pediatric and adolescent patient (Chapter 8), the geriatric patient (Chapter 9), interviewing patients of a different culture and language, and health beliefs in the interview (Chapter 10). The last chapter (11) in this section discusses communication with the patient in the office setting and specific issues in managed care settings as well as truthfulness and confidentiality.

The third section deals with challenges in interviewing and includes discussions on difficult patient-clinician interactions (Chapter 12), telling bad news (Chapter 13), and talking with patients about complementary and alternative medicine (Chapter 14). Issues related to malpractice and informed consent are, addressed in Chapter 15. Chapter 16 discusses patient education. The last chapter of the book is an annotated transcript of an interview with a new patient by a medical resident.

The book is very well written and easy to read. The skillful use of two tones of blue and grey increase the appeal of the text. The book is also generously illustrated with several dialogues between interviewer and patients to emphasize various points made in the text. Most of these dialogues are similar to what clinicians encounter in everyday life. Many clinicians will enjoy reading these interviews and may wonder how they would have responded under similar circumstances.

The book will be useful not only to medical students and clinicians in training, but also to all clinicians involved in direct patient care. Even seasoned clinicians will probably enjoy and benefit from reading the book. Educators, too, may find the references and suggested reading at the end of each chapter useful.