CMAJ • September 26, 2006; 175 (7). doi:10.1503/cmaj.1060138.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schattner, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schattner, A.
Related Collections
Right arrow Patient-caregiver communication

Letters

REAP: an extended agenda for the clinical interview

Ami Schattner

Hebrew University Hadassah Medical School, Jerusalem, Israel

The value of skillful communication in reaching the correct diagnosis, providing high-quality medical care and nurturing the patient–physician relationship cannot be overestimated.1 Communication starts with the medical interview. Physicians (and medical students) usually conduct these interviews according to the traditional structure of chief complaint, present illness, past medical history, review of systems and so on. However, both in the teaching of medical interviewing techniques and in practice, more emphasis is needed on the pursuit of several additional goals, which can be easily remembered by the mnemonic REAP: R for the "regular" components of the interview, E for both "emotion" and "education," A for "alarms" and P for "prevention" and "preferences."

Being sensitive to the patient's narrative and to nonbiologic components of the illness is increasingly recognized as crucially important.2,3 Because health literacy and patient awareness are the sine qua non of improved health outcomes and shared decision-making, education that begins at this early point would undoubtedly add to the patient's autonomy and satisfaction.4Potential "alarms" identified in the initial presentation require urgent attention, and delay in their recognition might prove dangerous to the patient. An inquiry about the current status of preventive care is mandatory to draw attention to deficiencies that often can be easily corrected. Finally, obtaining at least a rough idea about the patient's preferences5 reminds us that patients are different and that their differences ought to be respected.

Thus, REAP is a useful reminder of several essential aspects of the medical interview. Including these points will ensure that we harvest improved patient care.

REFERENCES

  1. Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ 2002;325:697-700.[Free Full Text]
  2. Schattner A. The emotional dimension and the biological paradigm of illness: time for a change. QJM 2003;96:617-21.[Free Full Text]
  3. Haidet P, Paterniti DA. "Building" a history rather than "taking" one. A perspective on information sharing during the medical interview. Arch Intern Med 2003;163:1134-40.[Abstract/Free Full Text]
  4. Heisler M, Bouknight RR, Hayward RA, et al. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med 2002;17:243-52.[CrossRef][Medline]
  5. Schattner A, Tal M. Truth telling and patient autonomy: the patient's point of view. Am J Med 2002;113:66-9.[CrossRef][Medline]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schattner, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schattner, A.
Related Collections
Right arrow Patient-caregiver communication