119to you?,” “How do you usually handle disagreements?,” and “What is your
understanding of his reasons for not wanting you to have this test?” Each of
these questions would take the conversation in a very different direction. Be
sure you know which direction you want to go. Also, the indiscriminate use of
questions may cause patients to withdraw (Guimarães et al. 2013 ). It’s tempting
to ask questions because they fill silences (something beginning counselors are
uncomfortable with), and they demand that patients respond (Martin 2015 ). You
should be careful about relying too much on them. As you gain experience, you
will appreciate the value of interspersing empathy and silence with questions.- Be specific and comprehensive. When gathering information, ask about your patient’s
thoughts, feelings, behaviors, and social systems (family, culture, peers, etc.)
(Hackney and Bernard 2017 ). You should also request concrete examples (Hill 2014 ).
For instance, a genetic counselor might ask: “What are your thoughts about genetic
testing?,” How do you feel about your risk for developing breast cancer?,” “How do
you usually make decisions?,” and “When you need support, who do you call?” - When discussing important topics, Fontaine and Hammond ( 1994 ) recommend
that you “...remember three Cs: Be concrete in getting specific details about the
events, ask about the context of the event, and look for conceptual themes in the
client’s stories about his or her life...Don’t be afraid to ask for more facts. It is
often in the retelling that important information is revealed or emotional connec-
tions are made” (p. 225). For example, a patient is referred for carrier testing for
Duchenne muscular dystrophy (DMD). As you are obtaining the family history,
the patient begins to cry. Questions you might ask include “How old were you
when your brother died?” (concrete), “Tell me about your relationship with your
brother?” (context), and “What was it like you for growing up with a brother with
muscular dystrophy?” (conceptual themes). - Be systematic. Stay with one topic before jumping to others. Follow up on con-
tent from your patient’s previous statement, or bring your patient back to a
topic if the patient is topic-hopping. Begin with more general questions and
ones that are easier and less threatening to answer. Gradually move to more
specific questions concerning more complex or more threatening issues. For
example, a genetic counselor might begin by asking “What is your understand-
ing of why your doctor referred you for genetic counseling?” (general) and
“What do you already know about your screening test results?” (more specific).
“How do you feel about your increased risk?” (more complex and potentially
threatening) - Keep questions simple. Ask one question at a time. Patients will be confused if
you string several questions together in one response. For example, “What do
you think about your risk for being a CF carrier, and do you think you might be
interested in carrier testing, or prenatal diagnosis?” You should separate these
into a series of questions. - Avoid interrogating. Questions may imply you are interrogating or judging the
patient (especially Why questions). Intersperse other types of responses with
questions. For instance, follow up a question with an empathy response that
clarifies or summarizes your patient’s answer to your question.
5.1 Obtaining Information from Patients