Timing in the Interview
One of the great benefits from being a member of the Medical Panels in Melbourne is that I get to work with other psychiatrists. All of them are experienced interviewers, they are all aware of the issues that need to be dealt with and the information that is required.
The differences are in the sequence of the interview. I have found this very informative. My usual style has been to establish the family network, find out any information about personal and family medical history, drug and alcohol use, accidents, psychiatric and/or psychological treatment both current and in the past and medication regime and other physical treatments. I then begin at the beginning and progressively move through family life, education, work history, marital history, recreational activity and drug and alcohol use prior to the injury or accident. I proceed to the injury/accident and what has happened since then leading to the current situation where I explore current symptoms and current treatment.
The problem with that approach has been that I sometimes find myself running out of time to comprehensively cover the current situation, which is ridiculous because that is often the focus of the interview.
I have noticed that other interviewers start with the injury and/or accident and work on from that to the current situation and then go back and look at those earlier matters. I have begun using that technique and I have found it very helpful.
Timing is critical in my interviews. If I don’t remain disciplined and on track then I run out of time to deal with essential matters. Part of the skill of the interview is to make sure that I have sufficient time to deal with the usual issues but also to deal with red herrings and other critical matters about which I had no knowledge before the interview.
The best interviewers, in my experience, seem to know intuitively when to move on to fresh areas and are able to work claimants like a sheepdog rounding up a flock of sheep. The worst interviewers seem to have no knowledge of time. I remember being in an interview which was about a man’s impairment assessment where the critical matter was his current symptomatology and level of function. To my astonishment the interviewer started to question him closely about the reasons for the breakdown of his first marriage some 30 years earlier! I was a little irritated.
I find that I have to be disciplined in a formal assessment, and follow more or less the same format you mention. Starting with the family tends to establish rapport. Sometimes I simply take a few initial spot comments of a few words under the headings of Work, Marriage, Children, Relationships, then move on more systematically. This can provide a framework and give context.
Sometimes, though, it happens that a “random walk” occurs, which can be efficient and relevant. Mostly in a treatment consultation, which one knows will be followed by other discussions, eliminating the time constraint.
Patients often tell me that the IME cut them off in the middle of something they wanted to convey. I sometimes indicate to them in advance that this may happen, and that all it means is that the examiner has got all he needs in that area, and that it doesn’t indicate any unfavourable view.
Byron