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INTRODUCTION

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A very good way to find out how another person is thinking or feeling is to ask him … At this point, however, a difficulty arises. If I am to acquire information in this way about another person's experiences, I must understand what he says about them. And this would seem to imply that I attach the same meaning to his words as he does, but how, it may be asked, can I ever be sure it is so?

AJ Ayers

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*Mr. Ketterman's Case

Is it possible to do an effective interview with a patient like Mr. Ketterman, with advanced Alzheimer's disease? Will I be able to trust the information I receive from Mr. Ketterman's wife? How can I show respect, genuineness and active listening to a patient with Alzheimer's? (See Appendix for Mr. Ketterman's health history.)

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In this chapter, we consider the patient interview as an essential diagnostic tool in physical therapy. We sometimes look upon patient interviewing as a simple process, just a sequence of questions and answers about symptoms and disabilities. In this view, the therapist's role is simply to know the right questions to ask. The patient's role is to respond with clear and honest answers. When this does not happen, we tend to discount the medical history in favor of more "objective" clinical data.

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However, any experienced clinician will tell you that this question-and-answer model is simplistic and self-defeating. It is not at all representative of successful clinician-patient interactions. Clinical interviewing is actually a complex interactive process that can produce highly reliable data about the patient's illness or injury, while at the same time building a therapist-patient relationship that facilitates cooperation and healing.1,2,3,4 To accomplish this, the therapist must consider illness data in the context of the patient's personhood so that judgments about (or enhancements of) its objectivity can be made. Here we discuss three aspects of the interview as a diagnostic and relationship-building tool.

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THE INTERVIEW AS A DIAGNOSTIC INSTRUMENT

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The Interview as a Diagnostic Instrument

  • Objectivity

  • Precision

  • Sensitivity and Specificity

  • Reliability

  • Skill

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Physical therapy combines the science of healing with the art of caring. These two aspects of practice intersect in the patient interview. The information learned in the interview guides further testing, therefore providing a foundation for scientific assessment and clinical reasoning. The interview is also the primary source of information about patient beliefs, values, attitudes, and circumstances. Finally, the interview is an essential tool in relationship building. For example, good communication skills are highly correlated to patient satisfaction.5,6 Given its importance in practice, we must approach the interview with the same scientific rigor that we use in learning and practicing other tests and measures.

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Physical therapy is a practical science, the science of helping people manage, reduce, and alleviate their ...

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