How should trainees be taught to open a clinical interview?
OBJECTIVE
To characterise the opening of secondary care consultations.


METHODS
We audio-taped 17 first consultations in medical clinics, transcribed them verbatim, and analysed verbal interactions from when the doctor called the patient into the consulting room to when she or he asked clarifying questions.


RESULTS
The interviews did not open with the sequence, reported by previous researchers, of 'doctor's soliciting question, patient's opening statement, interruption by the doctor'. Doctors (1) called the patient to the consultation; (2) greeted them; (3) introduced themselves; (4) made a transition to clinical talk; and (5) framed the consultation. They used a referral letter, the case notes, computer records and their prior knowledge of the patient to help frame the consultation, and did so informally and with humour.


CONCLUSIONS
These 5 steps could help trainees create a context for active listening that is less prone to interruption.
Walter
Alex
A
School of Medicine, University of Manchester, Manchester, UK.
Bundy
Chris
C
Dornan
Tim
T
D002983:Clinical Competence / Q000592:standards; D003142:Communication; D004504:Education, Medical, Undergraduate / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic / Q000592:standards*; D010817:Physician-Patient Relations; D013663:Teaching / Q000379:methods* / Q000592:standards