Integrating the Illness Meaning and Experience of Patients: the McGill Illness Narrative Interview Schedule as a PCM Clinical Communication Tool

Abstract

Despite extraordinary progress in biomedical technology and health care services, there is growing criticism of the depersonalization of clinical practice and the limits of medical and professional knowledge. In Person-centered Medicine (PCM), one of the aims is to give systematic attention to the illness meaning and experience of patients and to integrate into medical care the wellbeing, autonomy, spirituality and dignity of patients of diverse cultural backgrounds. There is however a dearth of validated tools clinicians can use to implement a PCM approach during the clinical communication tasks of diagnosis, negotiation of treatment choice and preventive behaviors. In this paper, we will argue that an abbreviated version of the McGill Illness Narrative Interview (MINI) has the potential to be used during clinical communication to implement a PCM approach. This paper will discuss epistemological issues of lay and medical knowledge as well as the patient’s empowerment that need to be addressed in clinical communication. Examples of corresponding clinical communication challenges posed by various medical specialties will be discussed, along with a critical overview of the conceptual models used to guide clinical communication in a PCM manner. Finally we propose that the development and evaluation of a clinical version of the MINI could help address some important challenges to implementing a PCM approach in a clinical context.