‘Time spent in communication (with patients)
is never wasted’.

Frances Cooke Macgregor (1906–2001)¹

Introduction

‘I do not much dislike the matter, but
The manner of his speech’.

William Shakespeare, Antony and Cleopatra (1606/7)²

The first step in reaching a clinical diagnosis is the information obtained from the patient interview. The patient interview is often the first contact between the patient and clinician, and any breakdown in communication at this stage may be irreparable. As such, the clinician’s approach should be courteous and professional, while avoiding being over‐familiar.

‘I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.’

Maya Angelou (1928–2014) (attributed)

The purpose is to establish effective communication and gain the trust of the patient in order to obtain the required information. Scully says, ‘The patient will know if you care, well before they care if you know’.³

The format of the patient interview should be a well‐organized, structured conversation; i.e. the clinician should direct the interview but the patient should be allowed to communicate their feelings and apprehensions to the clinician. The clinician will thereby gain insight into the patient’s aesthetic and/or functional concerns and, more importantly, their attitude towards it. The patient should be sitting comfortably at the clinician’s eye level and the initial interview/consultation should be, as far as possible, free from interruption.

Presenting complaint

The patient’s presenting complaint, as always, is very important. However, clinicians must be aware that patient’s presenting for an initial consultation may have numerous mixed emotions, and will often find it difficult to convey their reasons for seeking advice or treatment. Therefore, jumping in with the type of treatment that is required may well frighten the patient.

The patient should be encouraged to speak freely and honestly using their own words, though the clinician will often need to gently guide the interview. Leading questions, i.e. those which suggest the answer, should be avoided. Open questions, which do not suggest an answer, are preferable. It is far better to ask a patient what concerns they have rather than if the prominence of their chin is their main concern. Closed questions, which usually have a ‘yes or no’ answer, may occasionally be used during the interview in order to extract specific information, particularly in patients with rather vague concerns.

The clinician should demonstrate attentive listening by maintaining eye contact with the patient, occasionally nodding and making reassuring remarks such as ‘I understand’ and ‘Please continue’. It is also important to avoid the use of medical jargon and always use language that the patient can understand. It is sometimes said that the single biggest problem with communication is the illusion that it has taken place.

It is likely that the clinician’s body language and non‐verbal communication will dominate the patient interview. Psychologists claim that the majority of face‐to‐face communication is non‐verbal; the clinician’s body language and tone of voice are as important if not more important than the actual words used (see ‘Mehrabian’s rule’, Chapter 3).^{4, 5} Clinicians must never be, or appear to be, indifferent, unsympathetic or judgemental to a patient’s concerns.

The concerns of patients with facial deformities are likely to be either aesthetic, functional or a combination of both. Clinicians should be aware that patients may sometimes play down their aesthetic concerns initially, sometimes due to concerns that ‘aesthetic’ problems may not be covered by health service hospitals/insurance schemes or simply because they feel embarrassed. Informing the patient that the primary reason most patients seek dentofacial/craniofacial treatment is aesthetic may be helpful.