• The goal of the opening part of the interview is primarily to develop rapport and determine the tone of the interview.
• This starts with an introduction. Every physician should work on their introduction.
• You should learn more than one technique for introducing yourself and practice different types of introduction throughout your education and training to continuously hone and improve your interview techniques.

This may seem simple, but it actually is important. Your tone of voice, attitude, and title all play into how the patient perceives you. Try out different introductions and see which work for yourself. You also need to tell the patient what your role is and what the goal of the interview is. This can be very simple, but should not be neglected. Here is an example, but there are many different ways to do this.

• "I'm Dr. Dhawan, a psychiatrist here at the hospital. I've reviewed your chart and wanted to learn about your situation to see if I can help you."

On an inpatient and consult service, I would avoid the following broad questions:

1. What brought you to the hospital?
2. Why did you come to the hospital?

These are too broad and the patient won't know how to answer it effectively. You can get concrete answers such as "the police brought me here for no reason." You can also get irritable responses such as "i've told me story a million times, just ask the other people. You don't even communicate with each other." Instead I'd consider the following two types of questions.

After reading the chart, you can ask a more focused question about what brought the patient in the hospital. I read in your chart and notes that you were brought in because of thoughts of suicide. Things must be really bad for you now. What happened that made you think of ending your life? This is the answer you want to get when asking "what brought you into the hospital?" This more focused question not only demonstrates that you have read the chart, has some empathy, and will get you a more helpful answer. Again there are many themes and ways to focus the question depending on the situation.

The question that I (Dr Dhawan) use is "I read in your chart you have been thinking of suicide. Things must be bad for you now. How can I help you?" I learned this question from my attending in residency, Dr Mahapatra. This creates a collaborative tone, you immediately will get the patient's treatment goals, and can engage the patient more actively.

After establishing rapport through your introduction, you will presumably pursue information to build an H and P and help determine your management. Throughout your conversation there will be several moments where your response may help determine the maintenance of rapport. For instance, patient's will often tell us sensitive information about prior abuse or life challenges and often express strong emotion in these moments. It is of utmost importance in these moments to acknowledge the emotion expressed, to validate the feeling expressed, and to make statements reflecting empathy(note: this is important even if the patient is expressing a delusion as you should validate distress associated with the delusion). The following are examples:

Depressed patient: Dr: Have you had any history of abuse in your past?

Patient: I was raped as a child!(bursts into tears).

Dr: I am so sorry to hear that. I can see that this was very hard for you and is affecting you.

(This goes a step beyond just acknowledging that it happened with the standard "I'm sorry to hear that" response as this response shows you are paying attention to emotions expressed and not just content; thereby making the patient feel cared for and understood).

Psychotic patient: Dr: The ER staff told me you have been feeling fearful. What are you afraid of at this time?

Patient: The government is after me! They've tapped my phones and are inserting insects into my brain!. See them right here!(Patient motions at his head).

Dr: Goodness, that sounds very stressful. I'm sorry you are under such distress right now.

(Note that at no point in this response did we say "that is definitely true." However, we acknowledged the distress related to the delusional thought content. This validates the patients feelings and goes that extra step of making them feel cared for as you are acknowledging your visualization of their distress)