You may need to be especially flexible when obtaining the medical history of older patients. Here are some strategies to make efficient use of your time and theirs:
l If feasible, try to gather preliminary data before the session. Request previous medical records or, if there is time, mail forms that the patient or a family member can complete at home. Try to structure questionnaires for easy reading by using large type and providing enough space between items for people to respond. Questionnaires to fill out in the waiting room should be brief.
l Try to have the patient tell his or her story only once, not to another staff member and then again to you. For older patients who are ill, this process can be very tiring.
l Sit and face the patient at eye level. Use active listening skills, responding with brief comments such as “I see” and “okay.”
l Be willing to depart from the usual interview structure. You might understand the patient’s condition more quickly if you elicit his or her past medical history immediately after the chief complaint, before making a complete evaluation of the present illness.
l If the patient has trouble with open-ended questions, make greater use of yes-or-no or simple choice questions.
l Remember that the interview itself can be beneficial. Although you see many patients every day, you may be the only person your patient is socially engaged with that day. Your attention is important. Giving your patient a chance to express concerns to an interested person can be therapeutic.