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

More than 30 years of research have 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 definitions;3 acknowledging the role of nonverbal communication;4,5 pinpointing the shortcomings of isolated disease-oriented interviewing;6 demonstrating the key components of the clinician-patient interaction;7,8 identifying interviewers' negative responses to patients;9,10 demonstrating the principles11–14 and effectiveness of teaching biopsychosocial-patient-centered medicine;15–19 integrating patient-centered principles into treatment20–22 and prevention;23 exploring specific patient-centered approaches24,25 and alternative theories;26 critically reflecting on the biopsychosocial model;27,28 going beyond the dyadic interaction to other relational aspects of medical care;29–31 the important role of qualitative approaches in clinical research32,33 and linguistic study;34 the need for evidence-based interviewing;35,36 and connecting patient-centeredness with health outcomes, albeit with mixed results.37–40

In this chapter, we synthesize the argument for adopting patient-centered, biopsychosocial practices in lieu of a strict biomedical approach.

Most students recognize the powerful humanistic rationale for integrating patient-centered principles as giving 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 As we strengthen our patients' involvement, sense of self-sufficiency, and feelings of responsibility, they are more likely to be self-actualizing,42 an essential feature of positive patient outcomes.30 Thus, effective communication involves a patient who is the expert on her/his needs and a clinician who is the expert at translating these needs into mental and physical disease diagnoses and their treatment.42–44

Clinicians also benefit from a biopsychosocial/patient-centered approach. They report that the approach allows them to 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 if they were observed doing so, asking colleagues to “not tell anyone.” The idea of developing meaningful relationships and feelings of connectedness with patients, which was discouraged until the latter part of the twentieth century, has now been shown to have a variety of positive benefits45,46 for patients and clinicians both.39,46,47

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

1. Deficiencies of a solely clinician-centered approach.

   1. Physicians do not allow patients to complete their opening statement of symptoms and concerns in 69% of visits, interrupting patients after a mean time of 18 seconds.6

   2. Clinician-centered interviewing elicits only 6% of the ...