Basic Interviewing Skills

Most of us have heard the adage “It’s not what is said but how it’s said that makes a difference.” This is particularly true when discussing subjects that are inherently sensitive. What follows are specific suggestions for interviewing and counseling patients:

The Setting

It is very important the clinician and patient have some degree of privacy when discussing personally sensitive issues. Patients are typically reluctant to share sensitive information that might be overheard by others. For this reason, if you can offer a patient privacy, it’s best to do so. When privacy is limited, it is best to postpone discussions until the clinician is alone with the patient and to speak in a low volume.

The Initial Approach


Time is typically a consideration. If the clinician does not have time available to talk in-depth about the patient’s concern, she/he can give limited information (following the P-LI-SS-IT model discussed in this article) and make another appointment for the patient as soon as practical. This way the patient does not leave feeling as though their needs were not addressed.

When initiating conversations regarding oral malodor, it is important to use statements the clinician feels comfortable with. For example, after reviewing a patient’s medical history or oral examination, one might begin by using one of the following questions:

“Do you have any other dental concerns or problems regarding yourself or a family member’s oral health?”

“What dental products are you currently using on a regular basis?”

“Do you have questions regarding dental products you’ve seen advertised or heard about?“

If the patient says they do not have any concerns, it is recommended to accept this answer and do not press further. Let it be known that if in the future he or she does have concerns that they feel free to contact you at the office. Suppose the patient does have a concern, what does the clinician do?

Listening

The most common and serious mistake made by most clinicians is failing to really listen to what the patient has to say without interrupting. It is important we don’t jump in with suggestions before hearing the patient out. For example, a dental hygienist at a general practice clinic who was thoroughly “prepared” has the following conversation with a patient.

Hygienist: “Do you have any other dental concerns or problems regarding your oral health?”

Patient: “Well, yes…lately I’ve been having problems with bad breath…”

Immediately the eager dental hygienist launches in with:

Hygienist: “Oh, don’t worry about that. Bad breath is a common problem and we can schedule you for a breath assessment appointment. We have equipment that measures the amount of sulfur in your breath.”

The dental hygienist finally pauses as she realizes the young woman wants to say something further.

Hygienist: “Is there something else that you wanted to say?”

Patient: “Well, yes,” replied the woman. “I only have this problem when I get a sinus infection. Once the infection clears up, my breath problem does too. I just wanted to know if there was something I could use during those times?”
The crucial point: hear what the patient has to say before launching into a detailed presentation on the management of bad breath and offering a treatment plan. It is generally recommended once the patient begins talking, the clinician should be quiet and listen.
It is also important to determine whether the patient actually considers their concern a problem. They may simply be sharing information to find out what your opinion is. An example of a good follow-up question after the patient makes an initial statement is: “Does that bother you?” or “How do you feel about that?” The following conversation illustrates how the presented statement actually wasn’t a real problem.

Hygienist: “Do you have any other dental concerns or problems regarding your oral health?”

Patient: “Well, my co-worker always complains my breath smells like garlic.”

Hygienist: “I see. How do you feel about that?”

Patient: “To be honest with you, I don’t really care. I love garlic and eat it every day. I haven’t had a cold in three years and my cholesterol levels are great.”

Hygienist: “If I hear you correctly, you’re not concerned about your breath smelling like garlic and it isn’t really a problem that you’re asking me to help you solve.”

Patient: “That’s right. My partner eats garlic too. It doesn’t bother us at all that we smell like garlic, in fact, we actually like the smell of garlic.”

This example illustrates the fact we need to listen and let the patient define the problem, rather than we, as clinicians, always defining the problem for the patient.

Assume the clinician is familiar with the etiology and treatment of oral malodor, has learned and practiced various counseling and interviewing skills, has a setting that ensures privacy, and has an easy initial approach. He or she has learned how to listen and avoids interrupting. The patient has carefully described his or her bad breath concern and waits expectantly. At this point, how the clinician might respond will be the subject of the remainder of this paper. Keep in mind that when providing professional services to patients it is important to preserve the patients’ trust.