Studies show that doctors already interrupt patients for the first time after 15–20 s. Usually an open-ended first question (like: “What brings you here today?”) signals to the patient that he has space to speak. If the doctor lets the patient finish what he is saying, then it has been found that patients are more cooperative, keep their comments short, and only talk about relevant things. The average patient speaking time at the beginning of an interview is 92 s, and 78 % of patients stop within 2 min (Langewitz et al. 2002).

Open-ended questions are those that cannot be answered with a simple yes or no. By using open-ended questions, the doctor allows the patient space and signals that he is interested in the patient’s point of view. If, however, the patient cannot find the right words, it can be meaningful to help him with closed questions. No additional questions or explanations should be added after an open question has been asked, since the question will then curtain its supportive, patient-centered function.

A short pause of about 3 s has been found to be effective. In short pauses of silence, ideas occur to the patient that they may have forgotten. The pause permits the patient to continue speaking if there is something to add. The patient may express thoughts he/she had hesitated to address. The pause lowers the inhibition threshold for speaking about psychosocial matters. During the pause, the doctor emphasizes by listener signals (“hmm,” “yes”) and by his posture that he is listening to the patient and wants to give him the opportunity to continue speaking. Contrary to the fear that pauses might be interpreted as incompetence, pauses act as relief. It is pleasant to be able to think about something briefly. The doctor appears interested, calm, and sure.

Nonverbal signs like nodding when the patient hesitates encourage him indirectly to continue speaking. Eye contact signals attention and interest, and also encourages patients to continue speaking. Posture facing the patient emphasizes the doctor’s presence. Verbal possibilities to encourage the patient to speak are short expressions like “mhm” or “ah yes.”

Paraphrasing means repeating what has been said by the patient in one’s own words. The doctor takes on the patient’s viewpoint and focuses on that part of what the patient said that has the greatest relevant content. Using paraphrases is a good way to support the patient in emotional or personal topics. Questions tend more to disrupt. Paraphrasing often brings new perspectives for the patient that lead to what can be astounding solutions.

With paraphrasing, the doctor only picks up on the most important parts of the message, whereas summarizing covers a larger segment of the discussion. The doctor says in his own words what he has understood. The patient can then add information he had forgotten. This leads to agreement between the doctor and the patient. The doctor checks whether he has understood what the patient said. Summaries are also a suitable means of transition to a new discussion or to announce the end by summarizing the most important contents. In this way, it is also a doctor-centered communication technique.

Reflecting emotions is very similar to paraphrasing. However, the reflection refers primarily to emotional contents. Sometimes, these emotions are addressed directly. Sometimes, the response to emotions is based on an observation of body reaction or refers to what is said between the lines.

The doctor then waits to see whether the patient permits the doctor to pick up on his emotion. In the pause, he can collect his own feelings. Once the doctor has described the feeling, the patient has the possibility of talking further or changing the subject.

After an intensive emotional statement, it is especially important that the doctor pauses and does not immediately soothe or change the subject. For the patient, it is important that he does not feel dismissed but rather gains the doctor’s interest and sympathy. He experiences that emotions are acceptable.

A doctor-centered interview includes many structuring techniques (Table 6.2). They help to focus and streamline the interview. Thus, they complement the already-discussed patient-centered interviewing techniques .