Patient-centred Clinical Method Research Articles

The history of the patient-centred clinical method

The history of the patient-centred clinical method

Innovations in teaching the patient-centred clinical method

Innovations in teaching the patient-centred clinical method

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

In search of excellence. Expanding the patient-centred clinical method: a three-stage assessment.

Excellence in caring for the patient has been pursued in better technology and better management structures with multidisciplinary teams. Excellence is increasingly sought through taking the whole person seriously and in developing better ways of working with relationships. This paper traces the growth of ideas and their application in a university department of family medicine, toward a holistic and more patient-centred, three-stage clinical method. This three-stage assessment helps the patient and the physician to deal holistically with the problem. The biological, the psychological and the environmental systems as well as their interrelationships are considered as they impact on health and illness. This method of arriving at a 'best-fit' understanding of a person's problem, by the doctor and the patient together, helps to individualize the assessment and management. Excellence is more likely to be found when we care in an individualized way within a systems understanding.

What is general clinical competence? Facing the theoretical challenge to general practice

If general practice keeps on resorting almost totally to pragmatism, official features of the profession, such as comprehensiveness, will invite a limitless agenda. This lack of specificity also makes general practice seem replaceable, especially in countries where its traditional position is weak, as in Sweden. Still the majority of practitioners regard the contribution of their profession as specific. This situation offers a theoretical challenge, which if successfully answered could lead to the identification of crucial items of the clinical encounter and to the clarification of the position of general practice in medicine. The challenge lies in understanding and identifying that general clinical competence which mediates between the individual patient and biomedicine and which contributes to the competence of the skilful clinician irrespective of specialisation. The general practitioner is better placed than anybody else to refine that competence, as no distinct professional focus continuously distracts him from the general features of clinical medicine. After having analysed the relevance for "general clinical competence" of clinical epidemiology, of the "patient-centred clinical method ", of different problem-solving strategies and of communication respectively, this paper traces "general clinical competence" to a rather restricted but crucial area of clinical practice, which deals with the understanding of the symptom presentation. Usually this presentation is neither a clear-cut nor a direct offspring of disease but a personal communication of a change within the experience of the own body, "the lived-body". This understanding of the "lived-body" of the patient, which is here called bodily empathy, is often necessary to grasp the character of a symptom, and it is suggested that it is a major constituent of general clinical competence. It is also suggested that bodily empathy constitutes the basis of general practice as a discipline.

Teaching the patient-centered clinical method in primary care: A program for community physicians

We developed and evaluated a program of continuing medical education for a group of experienced family physicians. The course content focused on the patient-centered clinical method. The method emphasizes understanding the patient's point of view of his or her illness and collaboration between doctor and patient. The small-group format, utilizing role-playing and videotaped examples, was seen as a viable approach to continuing medical education. The participants responded favourably to the six-week course and found the conceptual framework valuable for family practice.

The patient-centred clinical method. 2. Definition and application.

In this article, the patient-centred clinical method is described in operational terms. Definitions are given for the patient's expectations, feelings and fears. The physician behaviours described are: facilitations, acknowledgements, cut-offs and returns. Using the definitions, a method was devised for scoring video-taped interviews for the degree of 'patient-centredness'. The method proved to have good inter-observer reliability.

The patient-centred clinical method. 3. Changes in residents' performance over two months of training.

A method for assessing the patient-centred approach was used to identify changes taking place in the interviewing behaviour of 13 residents during two months in a teaching practice. The descriptive study confirmed the prediction that the residents' approach would become more patient-centred. A statistically significant change from August to October was found in the number of facilitating behaviours shown by residents (P less than 0.05) and there was a change in the number of fears expressed by patients (P less than 0.10). Increases in the number of expectations, feelings and prompts were noted but were not significant. The frequency with which residents cut off patients' expressions increased on the whole, although not significantly. The findings suggest that while these residents had succeeded in increasing their facilitating behaviours over two months (one-sixth of their family medicine experience) they had not yet found ways of responding to the many problems elicited.