Up until now you have worked to create an effective clinician–patient relationship, elicited information on the patient's symptoms and the personal and emotional context, and translated this information into a biopsychosocial story about a person and her or his illness. Now how do you summarize and transmit this information to others?
You have gathered a great deal of information and synthesized it sensibly, but there remains the task of meaningfully summarizing to reflect the essence of the patient, that is, the biopsychosocial story, which includes disease diagnoses.1 Our multidimensional scheme integrates mind (psychosocial) and body (biomedical) components to describe the whole person and his or her dynamically interacting parts.
There are three components of the patient's biopsychosocial description: Relationship story, Personal story, and Disease story/Diagnoses (recalled by the mnemonic RPD). These are outlined in Table 9-1, and illustrated at the end of this chapter and at the end of Appendix D where Mrs. Jones' story is summarized.
Table 9-1. The Components of the Patient's Biopsychosocial Storya ||Download (.pdf)
Table 9-1. The Components of the Patient's Biopsychosocial Storya
Disease story (diagnoses)
Your experience during the entire encounter with the patient allows you to synthesize a story of the clinician–patient relationship.2,3
Your first task is to sort out and be conscious of your own personal feelings and resulting behaviors toward the patient or the patient's circumstance. For example, fear of doing harm could lead to avoiding a discussion of death, fear of contracting a disease might lead to an avoidance of touching the patient, or sexual feelings toward a patient could result in excessive attention or avoidance. These feelings and responses are not necessarily expressed in a written report or verbal presentation; only information that you are comfortable having many others know should be divulged. Reserve more personal feelings and responses for discussion with your preceptor(s), as this can be very useful in developing your personal awareness.4
Because personality manifests itself in relationships, it is part of the relationship story. Make your observations throughout the interview and identify the patient's dominant personality style as dependent, histrionic, obsessive, self-defeating, narcissistic, paranoid, or schizoid (or other types), as outlined in Chapter 8. For most people, this designation depicts their style of interacting with others and is not abnormal. When personality style interferes with normal functioning, it is called a personality disorder and is so identified in the summary.5
Finally, consider the interactional process itself and note any difficulties. Does ...