Introduction

The medical interview is central to clinical practice. It is the essential unit of medical time, a critical few minutes for the doctor to help the patient with his or her problems. To achieve an effective interview, doctors need to be able to integrate four aspects of their work which together determine their overall clinical competence:

• knowledge

• communication skills

• problem solving

• physical examination

These four essential components of clinical competence are inextricably linked: outstanding expertise in any one alone is not sufficient.

Strangely then, traditionally the medical interview has been described only in terms of its output, the information that needs to be gathered from the patient in order to make a diagnosis. Until recently, very little attention has been paid to how to go about the process of such information gathering, or to what skills or techniques would aid the retrieval of the data required by the doctor.

Of course, data gathering is only one of the goals of medical interviewing. Even less attention has been traditionally paid to how to build a relationship with the patient, how to organize and structure an interview, how to explain and make plans with the patient or indeed to how the patient feels about the process.

There is also a strong argument to be made that the traditional data set required by doctors has been too restrictive, focusing only on the symptoms and signs of disease that help the clinician to make a diagnosis, at the expense of gathering information about the patient's perspective of the illness and in particular his or her ideas, concerns, expectations and feelings.