Appendix B: Research and Humanistic Rationale for Patient-Centered Interviewing

INTRODUCTION

Nearly 40 years of research has confirmed the value of integrating patient-centered and clinician-centered interviewing skills into most encounters, a few of which studies are summarized here.

Teachers, scholars, and researchers have advanced the field by identifying three functions of the clinical interview^1,2; refining patient-centered definitions³; acknowledging the role of nonverbal communication^4,5; pinpointing the shortcomings of isolated disease-oriented interviewing⁶; demonstrating the key components of the clinician–patient interaction^7,8; identifying interviewers’ negative responses to patients^9,10; demonstrating the principles^11–14 and effectiveness of teaching biopsychosocial/patient-centered model^15–19; integrating patient-centered principles into treatment^20–22 and prevention²³; exploring specific patient-centered approaches^24,25 and alternative theories²⁶; critically reflecting on the biopsychosocial model^27,28; going beyond the dyadic interaction to other relational aspects of medical care^29–31; identifying the important role of qualitative approaches in clinical research^32,33 and linguistic study³⁴; emphasizing the need for research to direct the interviewing skills that should be used^35,36; and connecting patient-centeredness with health outcomes, albeit with mixed results.^37–40

In this chapter, we synthesize the arguments for adopting patient-centered, biopsychosocial practices instead of a solely disease-oriented, biomedical approach.

MORE HUMANISTIC

Most students recognize the powerful humanistic rationale for integrating patient-centered principles: it gives them tools to respond to patients’ biological, psychological, and social needs. Responding in this way allows us to hear and understand our patients in a way that validates them as human beings rather than as objects of study.⁴¹ This also strengthens our patients’ involvement, sense of self-sufficiency, and feelings of responsibility, leading to self-actualization,⁴² an essential contributor to the improved patient outcomes seen with patient-centered care.³⁰ Thus, effective communication involves a patient who is the expert on her/his needs and experiences, and a clinician who is the expert at responding to these needs and experiences, identifying the responsible diagnoses, and determining appropriate treatments.^42–44

Clinicians also benefit from using a biopsychosocial/patient-centered model. They report that they can more fully embody such human qualities as respect, empathy, humility, and sensitivity. Because these qualities seemed less valued during their training, physicians of the past often felt guilty in expressing them, asking colleagues to “not tell anyone” if they were observed doing so. The idea of developing meaningful relationships and feelings of connectedness with patients, which was discouraged until the latter part of the 20th century, has now been shown to have a variety of positive benefits^45,46 for patients and clinicians alike.^39,46,47

MORE SCIENTIFIC

Integrating patient-centered interviewing skills is more scientific than isolated clinician-centered ...