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The skill of "active listening" lies at the heart of a good patient interview," says Rajita Bhavaraju, MPH, health educator at the New Jersey Medical School’s TB Model Center in Newark. Bhavaraju addressed this subject in a class called "Effective TB Interviewing and Contact Investigation," held in October at the center.
Cultivating active listening means, first of all, not approaching an interview too intently focused on an agenda. "That’s probably the most common mistake we see in novice interviewers," says Bhavaraju. "They go through the interview almost like a checklist." That approach often results in interviewers missing important cues from the patient — perhaps about barriers to compliance. "If the patient keeps coming back to the subject of child care, for example, the interviewer has to be able to recognize that those needs could be a barrier to adherence," she adds. "Interviewers need to be able to adjust."
Along with a patient approach, interviewers need to avoid certain kinds of behaviors to keep the information flowing. Avoid close-ended questions requiring only a "yes" or "no" answer, Bhavaraju says. For example, asking a patient, "Do you live with anyone?" will probably elicit less information than "Tell me about the people you live with."
Such an approach also pays off by establishing rapport, Bhavaraju adds. Rapport between interviewer and patient is crucial because "in many cases, the same people who conduct the initial interview will be managing the case," she points out. "It’s often a long-term relationship." Plus, a patient who trusts an interviewer is more likely to provide important information.
That doesn’t mean the patient does all the talking, Bhavaraju says. Interviewers have to get across certain concepts, such as the importance of adherence. In those instances, it’s important "not to talk over the patient’s head," she says. The workshop uses a variety of interactive teaching techniques, including the use of so-called "standardized patients" — actors assigned to play a patient with a particular history. It’s a technique often employed by medical schools, Bhavaraju says.
"We have an interviewer go through an entire interview with an actor," she says. "We ask actors to react to the interviewer’s style." The actors are trained to adjust their reactions as well, Bhavaraju says, easing up "if someone is obviously struggling, and in other cases, really challenging people."
Though the primary aim is to build a good interviewing style, the course addresses cultural competency and different kinds of contact investigation. For the first year, this month’s class includes an actor who plays a generic foreign-born patient (from the country of "Slowamba"), complete with whatever accent the actor wants to try out, as well as strong beliefs about the supposed protective value of the bacille Calmette-Guerin vaccine.
Each year’s class is a bit different from those of previous years, says Bhavaraju. Invariably, participants have a wide range of experience, too. "We have some people with a few weeks’ experience; others have been at this for more than 20 years." Those with more experience often make important contributions to the class, she adds. The class is offered once or twice a year, Bhavaraju says. For those unable to attend, the course materials, along with instruction about how to use them, are offered to TB control divisions.
For more information, contact Bhavaraju at the TB Model Center at (973) 972-3270.