When you are already done with your USMLE Step 2 CK, there will be another hurdle you need to surpass – USMLE Step 2 CS wherein a simulated doctor-patient situation will be provided and you will act as the doctor. You will be expected to use your clinical eye, communication and interpersonal skills in establishing rapport, and eliciting vital information and generate an accurate and factual medical history and notes. As such, it is with great importance that you take note of the four questions that will in one way or another cause the patient to clam up.
Using Questions Requiring Only A “Yes” or “No” Answer. Questions that can be answered by simply saying “yes” or “no” tend to cut off discussions, even when the person might wish to go on. Consider the following question:
Doctor: Did you have a good day?
The question almost begs for noncommittal answer, which tells you very little. A better way to comment is as follows:
Doctor: Tell me about your day.
Another pitfall is to pose a question to which the patient can say “no” when his answer could present a problem. Consider the following question which you might ask from a post-operative patient:
Doctor: Are you ready to get out of bed?
By offering the patient the chance to say “no,” the nurse may have created difficulties if the patient is to be out of bed.
There are times when questions can be answered with “yes” or “no” are legitimate. For instance:
Doctor: Do you have pain when I move your arm this way?
The problem arises when you seek more detailed information than a simple “yes” or “no” offers or when the answer may create difficulty.
Using Questions Containing The Words “Why” and “How.” Questions using “why” and “how” tend to be intimidating. Though in the simulated doctor-patient USMLE Step 2 CS interview, the patient may answer, after completing the USMLE Steps, you will realize that this is not a technique that works in the actual hospital setting.
Doctor: Why were you not tired enough to sleep?
Doctor: How did you ever decide to go on a crash diet?
These two questions would be better stated as follows:
Doctor: What where you doing while you were unable to sleep?
Doctor: What things prompted you to decide to go on a crash diet?
Questions That Probe for Information. Questions that appear to probe for information tend to cut off communication. Patients who are made to feel as though they are receiving the “third degree” becomes resentful and will usually stop talking and try to avoid further conversation.
Although you may feel that you need more information, it is better to follow the patient’s lead. Letting the patient take the initiative allows him to delve more deeply at a time when he is ready. The person who says “Let us get to the bottom of this” is likely to destroy conversation unless the patient is ready to face the real cause of the problem.