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--- interview [2020/10/16 20:55] – [Opening] quinby
+++ interview [2020/10/16 21:10] (current) – quinby
@@ Line 19: / Line 19: @@
 === A simple open-ended question ===
 The question that I (Dr Dhawan) use is "I read in your chart you have been thinking of suicide. Things must be bad for you now. How can I help you?" I learned this question from my attending in residency, Dr Mahapatra. This creates a collaborative tone, you immediately will get the patient's treatment goals, and can engage the patient more actively.
+=== Maintaining rapport during your interview ===
+After establishing rapport through your introduction, you will presumably pursue information to build an H and P and help determine your management. Throughout your conversation there will be several moments where your response may help determine the maintenance of rapport. For instance, patient's will often tell us sensitive information about prior abuse or life challenges and often express strong emotion in these moments. It is of utmost importance in these moments to acknowledge the emotion expressed, to validate the feeling expressed, and to make statements reflecting empathy(note: this is important even if the patient is expressing a delusion as you should validate distress associated with the delusion). The following are examples:
+ __Depressed patient:__
+Dr: Have you had any history of abuse in your past?
+Patient: I was raped as a child!(bursts into tears).
+Dr: I am so sorry to hear that. I can see that this was very hard for you and is affecting you.
+(This goes a step beyond just acknowledging that it happened with the standard "I'm sorry to hear that" response as this response shows you are paying attention to emotions expressed and not just content; thereby making the patient feel cared for and understood).
+ __Psychotic patient:__
+Dr: The ER staff told me you have been feeling fearful. What are you afraid of at this time?
+Patient: The government is after me! They've tapped my phones and are inserting insects into my brain!. See them right here!(Patient motions at his head).
+Dr: Goodness, that sounds very stressful. I'm sorry you are under such distress right now.
+(Note that at no point in this response did we say "that is definitely true." However, we acknowledged the distress related to the delusional thought content. This validates the patients feelings and goes that extra step of making them feel cared for as you are acknowledging your visualization of their distress)