Psych · Professional practice
Clinical Communication and Psychiatric Interviewing
Also known as Psychiatric interview · Clinical communication skills · Medical interview · Breaking bad news · Shared decision making · Verbal de-escalation
Exam-exhaustive fellowship topic on clinical communication and psychiatric interviewing — interview structure and micro-skills (open-to-focused funnelling, summarising, signposting), alliance with hard-to-engage patients, collateral and informant interviews, breaking bad news with SPIKES, explaining diagnosis and negotiating treatment with shared decision making, angry and distressed patients, interviewing psychotic, manic, mute and suicidal patients, telephone and telehealth communication, documentation of conversations, and cultural and interpreter-mediated interviews. FRANZCP W08 anchor; MRCPsych CASC explicit.
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Red flags
- The baked-in answer — 'you're not suicidal, are you?' — ask directly; asking about suicide does not induce ideation
- Using family members, especially children, as interpreters — errors, omissions, and breached trust
- Promising absolute confidentiality before hearing what the patient will say
- Premature reassurance — the blocking behaviour that sends the real concern home unspoken
- Documenting 'SI denied' without recording the question asked and the patient's own words
- Cornering an agitated patient or blocking your own exit — safety is positioning before it is pharmacology
Meet the patient
Tuesday, 9:07. A 58-year-old man sits in your clinic room, referred for "low mood since his stroke". He told the triage nurse he was "fine". The GP letter says "low mood?" and nothing else. His wife is outside asking what is wrong with him. You have 50 minutes. The examiner's version of this moment gives you seven.[1][3]
Every registrar's first instinct: start the checklist — mood, sleep, appetite, guilt, done. Every examiner's first question: he told the nurse "fine" — what would make him tell you the truth? This topic is the answer to that question.[4][8]
References20ShowHide
- [1]Smith RC, Hoppe RB The patient's story: integrating the patient- and physician-centered approaches to interviewing Ann Intern Med, 1991.PMID 1872495
- [2]Kurtz S, Silverman J, Benson J, et al. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides Acad Med, 2003.PMID 12915371
- [3]Maguire P, Pitceathly C Key communication skills and how to acquire them BMJ, 2002.PMID 12351365
- [4]Maguire P, Faulkner A, Booth K, et al. Helping cancer patients disclose their concerns Eur J Cancer, 1996.PMID 8695247
- [5]Stewart MA Effective physician-patient communication and health outcomes: a review CMAJ, 1995.PMID 7728691
- [6]Levinson W, Roter DL, Mullooly JP, et al. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons JAMA, 1997.PMID 9032162
- [7]Hojat M, Gonnella JS, Nasca TJ, et al. Physician empathy: definition, components, measurement, and relationship to gender and specialty Am J Psychiatry, 2002.PMID 12202278
- [8]McCabe R, Heath C, Burns T, et al. Engagement of patients with psychosis in the consultation: conversation analytic study BMJ, 2002.PMID 12433765
- [9]Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer Oncologist, 2000.PMID 10964998
- [10]Fallowfield L, Jenkins V, Farewell V, et al. Enduring impact of communication skills training: results of a 12-month follow-up Br J Cancer, 2003.PMID 14562015
- [11]Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice J Gen Intern Med, 2012.PMID 22618581
- [12]Deegan PE, Drake RE Shared decision making and medication management in the recovery process Psychiatr Serv, 2006.PMID 17085613
- [13]Richmond JS, Berlin JS, Fishkind AB, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup West J Emerg Med, 2012.PMID 22461917
- [14]Haas LJ, Leiser JP, Magill MK, et al. Management of the difficult patient Am Fam Physician, 2005.PMID 16342837
- [15]Dazzi T, Gribble R, Wessely S, et al. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med, 2014.PMID 24998511
- [16]Flores G The impact of medical interpreter services on the quality of health care: a systematic review Med Care Res Rev, 2005.PMID 15894705
- [17]Lewis-Fernández R, Aggarwal NK, Lam PC, et al. Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial Br J Psychiatry, 2017.PMID 28104738
- [18]Hilty DM, Ferrer DC, Parish MB, et al. The effectiveness of telemental health: a 2013 review Telemed J E Health, 2013.PMID 23697504
- [19]Jorm AF, Jacomb PA The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms Psychol Med, 1989.PMID 2594878
- [20]Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead Ann Intern Med, 2012.PMID 23027317