You are a primary care clinician seeing patients in your office. You glance at the intake form of your last patient of the day and notice that she is a 38-year-old woman with left-sided neck pain for 1 week. She is a colleague's patient whom you have never met before. You have 15 minutes for her visit.
- How can you elicit the patient's full agenda for the visit in 1 minute or less?
- How can you elicit a patient-centered description of her neck pain?
- How can you obtain the personal and emotional context of her neck pain?
Effective medical interviewing is a skill that must be systematically learned and practiced. Traditionally, students were trained to use a primarily clinician-centered approach to elicit biomedical data.1 The interviewer asked specific, often closed-ended, questions in order to help make a diagnosis. Unfortunately, this approach often resulted in an incomplete and/or inaccurate database and limited the ability of the interviewer to establish rapport with the patient. Patient-centered interviewing2 focuses on the personal and emotional context and encourages the patient to spontaneously describe his or her symptoms. The interviewer efficiently establishes a relationship with the patient by focusing on the patient's emotions and concerns. When integrated with more traditional clinician-centered interviewing, patient-centered interviewing enables the interviewer to obtain a more complete biopsychosocial story.1
Unfortunately, many healthcare providers still use an exclusively clinician-centered style that discourages patients from expressing their concerns.3 The data collected are skewed toward physical symptoms and often misinterpreted because of missing psychosocial context. In contrast, interactions that encourage patients to freely express their concerns yield more valid data and tend to improve patient satisfaction, compliance, knowledge, and recall.4–6 They also decrease doctor-shopping and lawsuits.7 Interactions that use a patient-centered style have also resulted in better blood pressure and diabetic control,8 better perinatal outcomes,9 shortened lengths of stay and improved mortality in critically ill patients,10 and improved cancer outcomes.11
|Biopsychosocial (BPS) model||The BPS model describes the patient as an integrated mix of his or her biologic, psychological, and social components. It differs from the biomedical model, which describes the patient only in terms of disease (physical or psychiatric).|
|Patient-centered interviewing||The interviewer encourages the patient to express what is most important to him or her and facilitates the narration of the patient's story.|
|Clinician-centered interviewing||The clinician takes charge of the interaction to acquire specific details not provided already by the patient, usually to diagnose disease or to develop the database (see Chapter 4).|
|Integrated patient-centered and clinician-centered interviewing||The interviewer uses both patient-centered and clinician-centered interviewing to elicit physical, personal (includes social), and emotional data from the patient and then synthesizes the data into the biopsychosocial story.|
This chapter describes a step-by-step, behaviorally defined, patient-centered interviewing method that has been shown in a randomized controlled ...