Talking to Patients About Sensitive Topics: Communication and Screening Techniques for Increasing the Reliability of Patient Self-Report


Explores communication techniques that decrease patient and physician anxiety and increase the accuracy and specificity of patient reporting about sensitive topics, such as substance abuse and partner violence.

Resource Materials


Developer: University of North Dakota School of Medicine & Health Sciences

Curriculum resource type: Lecture

Method used: Didactic presentation with handouts and PowerPoint slides; small groups

Intended audience: First- and second-year medical students

Implementation time: 1.5–2 hour lecture; 2-hour clinical skills practice session

Additional components: Student handout; speaker notes/instructor guide; patient history format handout; medical interviewing checklist used for faculty and peer evaluation of interviewing skills; references and additional reading

Educational objectives:

  • Learn communication techniques that decrease patient and physician anxiety and increase the accuracy and specificity of patient self-report about sensitive topics.
  • Understand, practice, and demonstrate basic screening protocols for assessing alcohol/drug use, intimate partner violence, and sexual practices and concerns.
  • Identify, practice, and demonstrate understanding of specific communication techniques that increase the reliability and specificity of patient self-report when discussing sensitive topics.

Evaluation tools: Faculty and peer observation of interviewing skills including: oral self-evaluation, oral feedback from faculty and peers, and written feedback using the medical interviewing checklist.

Curriculum resource description: This curriculum module focuses on interviewing patients about sensitive subjects (substance and alcohol use/abuse, intimate partner violence, and sexual history). Although the content for each of these subjects is different, interviewing techniques for decreasing patient anxiety and resistance in order to obtain accurate information are very similar. This module can be used as part of a course on medical interviewing or as a stand-alone module if students have received the prerequisite instruction in basic interviewing skills and history taking.

The format for this product includes a lecture using PowerPoint slides, followed by a clinical skills practice session using standardized patients (SPs). Each session includes eight students and a preceptor (either a primary care physician or a clinical psychologist). Students take turns playing the role of a physician who is conducting a 20- to 30-minute interview of an SP. The other students and preceptor observe the interview and complete a medical interviewing checklist. Following the interview, the SP gives feedback to the student. After the SP leaves the room, the interviewer evaluates his/her performance, the preceptor and the students discuss the strengths and weaknesses of the interview, and the interviewer receives the written feedback from peers and the preceptor on the interviewing checklist.

Key words: Drug abuse; drug addiction; substance abuse; patient interviews; substance abuse screening; social history; alcohol use history; medical history; sensitive topics; sexual history; intimate partner violence; domestic violence; communication techniques; peer evaluation