One type of interview error I run across among both adult and child adolescent psychiatrists preparing for their oral boards is what I call the ‘doughnut interview.”
What on earth is a doughnut interview?
What is it about a doughnut that stands out? It’s the whole in the middle, of course! (BTW, if your culinary tastes run to a less sweet alternative, you have my permission to call this the “bagel interview.”)
In effect a doughnut interview is one in which the interviewing psychiatrist is working hard the entire time of the interview to gather information. They’re not slacking off. They’re working hard asking important questions. But here’s the problem.
They’re barely focusing on the main, the most important problems. The chief complaint / diagnostic impression remains grossly underassessed. Thus, it becomes, in effect, an interview with a whole in the middle. As a listener, I learn a ton about the patient, but unfortunately very little about the main problems. Here are a couple of examples.
Example 1: At a recent course, the doctor interviewed a 13 year old boy who stated that he was seeing a counselor at school because he had received many after-school detentions and a recent suspension for misbehaving. The interviewer did correctly focus on assessing ADHD symptoms. And indeed there some were present. BUT the interviewer never assessed for disruptive, oppositional, intimidating, or violent behaviors. In fact, the word ‘bullying’ was never uttered in this interview. Now, I don’t know if any of these behaviors were present – that’s the whole problem! Don’t you think those are crucially important areas to at least screen for in a boy who says he’s been in detentions and recently suspended?
Why did this happen in this case? I had my clue when as soon as the presentation was over, the candidate blurted out, “I really like this kid.” “I know, “I said, “that’s the problem. Your positive counter-transference blinded you to the possibility that this boy engages in disruptive or even vioent behaviors.”
Example 2: The doctor interviewed an 18 year old young man who denied currently being in psychiatric treatment. In the history the following three problem areas became evident: 1. History of depression with neurovegetative symptoms lasting for one year at the age of 14 following the death of an uncle; 2. History of alcohol use each weekend; and 3. History of medication treatment for ADHD from 8th to 10th grade.
In each of these three main problem areas the interviewer missed crucially important information. After listening closely to this interview I would still have had a very hard time coming up with a sensible treatment plan because there was so much left unassessed. I did not learn enough about the symptoms, the triggers, the current levels of symptoms and dysfunction. And, let me stress, the issue here was not so much a matter of lack of time, but rather a lack of focus on the core problems.
That’s it for today. Let me know what you think or if you have your own examples.
Today’s Quote
“We are not cisterns made for hoarding, we are channels made for sharing.” – Billy Graham
Thanks and happy studies ….
Jack Krasuski, MD
877-225-8384
