Patient-centered Interviewing Research Articles

"Lupus Doesn't Have Me, I Have Lupus": Using Patient-Centered Interviews to Understand Medication Nonadherence.

Lupus nephritis (LN) is the most common cause of kidney injury in systemic lupus erythematosus and associated with higher morbidity and mortality. Low medication adherence correlates with adverse clinical outcomes. In a large, integrated health system at Kaiser Permanente East Bay Area, the authors identified mycophenolate mofetil (MMF) prescriptions for LN and collected patient demographics, medication adherence, and copay data. They interviewed patients with low medication adherence rates to understand contributing factors, such as side effects, cost, refill processes, and laboratory draws. Adherence was defined as a proportion of days covered at > 80%. The proportion of days covered is the number of days covered by a medication divided by the number of days in a defined period. Between November 30, 2021, and November 30, 2022, the authors identified 36 patients with LN on MMF. Almost a third (11/36) of these patients were nonadherent to medication. More than half (7/11) of these patients agreed to be interviewed. They identified the following causes of medication nonadherence: forgetfulness (57%, or 4/7), incomplete laboratory work (28%, or 2/7), medication cost (14%, or 1/7), and intentionally missed doses (14%, or 1/7). No patients identified medication side effects as a cause. The median 30-day copay for MMF was $4.55, and 28% (2/7) of patients paid $0 for their medications. In the authors' integrated health system, 69% of their patients with LN on MMF were adherent to their medication regimen. Forgetfulness was a challenge for the nonadherent patients. Kaiser Permanente East Bay Area provides convenient refills and laboratory draws; this likely facilitates medication adherence.

Generation and content validation of physical and vocational rehabilitation in paraplegics: An interview guide

BACKGROUND: As the mainstay treatment for paraplegics is rehabilitation, patient satisfaction and experience are important predictors of the care being provided. To understand whether the current arrangements of rehabilitation services are sufficient to help an individual with paraplegia return to a productive life. Patient-centered interview guides to explore their rehabilitation experience are lacking, which calls for a generation of the same. OBJECTIVE: To generate and validate an interview guide (PVR-PIG), which aims at understanding and exploring the experience of physical and vocational rehabilitation for individuals with paraplegia. METHODS: After an extensive literature search, an initial 27-item interview guide was formulated under three domains: general experience and expectations from rehabilitation care; physical rehabilitation experience, barriers, and facilitators; and vocational rehabilitation. Later, it was sent for content validation to a multidisciplinary expert panel with prior experience in spinal cord injury (SCI) management. RESULTS: After suggestions were received from nine experts with an average of 14 years of experience in dealing with SCI, a 15-item interview guide was finalized, with a scale-level and item-level content validity index of 0.897 and 0.78–1, respectively. CONCLUSION: The generated interview guide (PVR-PIG) aimed to explore physical and vocational rehabilitation experiences in paraplegics was found to be valid.

Patient-identified Treatment Attributes Among Older Men With Stress Urinary Incontinence: A Qualitative Look at What Matters to Patients Making Treatment Decisions

To investigate which treatment attributes matter to patients with stress urinary incontinence (SUI), why and how they matter, and the context in which patients consider treatment attributes. Nearly a quarter of older men have decisional regret following SUI treatment. Knowledge of what matters to patients when making SUI treatment decisions is necessary to improve goal-concordant care. We conducted semi-structured interviews with 36 men ≥65 years of age with SUI. Semi-structured interviews were conducted by telephone and transcribed. Four researchers (L.H., N.S., E.A., C.B.) coded the transcripts using both deductive and inductive codes to identify and describe treatment attributes. We identified 5 patient-derived treatment attributes of interest among older men with SUI who have faced treatment decisions: (1) dryness, (2) simplicity, (3) potential need for future intervention, (4) treatment regret/satisfaction, and (5) surgical avoidance. These themes reliably emerged in our patient-centered interviews from within various contexts, including prior negative healthcare experiences, the impact of incontinence on daily and quality of life, and the mental health burden of incontinence, among others. Men with SUI weigh a variety of treatment attributes in addition to dryness, a traditional clinical endpoint, and do so within the context of their individual experience. These additional attributes, such as simplicity, may run counter to the goal of dryness. This suggests that traditional clinical endpoints alone are not adequate for counseling patients. Contextualized patient-identified treatment attributes should be used to create decision-support materials to promote goal-concordant SUI treatment.

Beyond the NURSE Acronym: The Functions of Empathy in Serious Illness Conversations.

Empathic communication, defined as both responding to emotions and actively appreciating another's world view, is associated with better outcomes for patients and families, including decreased anxiety and depression, and improved coping 1 Kelley JM Kraft-Todd G Schapira L Kossowsky J Riess H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014; 9: e94207https://doi.org/10.1371/journal.pone.0094207 Crossref PubMed Scopus (420) Google Scholar , 2 Hoffstädt H Stouthard J Meijers MC et al. Patients’ and Clinicians’ Perceptions of Clinician-Expressed Empathy in Advanced Cancer Consultations and Associations with Patient Outcomes. Palliative Medicine Reports. 2020; 1: 76-83https://doi.org/10.1089/pmr.2020.0052 Crossref Google Scholar , 3 Neumann M Wirtz M Bollschweiler E et al. Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ. Couns. 2007; 69: 63-75https://doi.org/10.1016/j.pec.2007.07.003 Crossref PubMed Scopus (186) Google Scholar , 4 Flickinger TE Saha S Roter D et al. Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. Patient Educ. Couns. 2016; 99: 220-226https://doi.org/10.1016/j.pec.2015.09.001 Crossref PubMed Scopus (68) Google Scholar , 5 Hojat M Louis DZ Markham FW Wender R Rabinowitz C Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad. Med. 2011; 86: 359-364https://doi.org/10.1097/ACM.0b013e3182086fe1 Crossref PubMed Scopus (678) Google Scholar . Despite this, clinicians who have not undergone formal communication training typically focus on information exchange and miss patients’ emotional and social cues. To address this gap, we use the acronym NURSE (Name, Understand, Respect, Support, Explore) 6 Fortin AH Dwamena FC Frankel RM Smith RC Smith's Patient-Centered Interviewing : An Evidence-Based Method. 4th ed. McGraw-Hill Education, New York2019 Google Scholar ,7 Back AL Arnold RM Baile WF Tulsky JA Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005; 55: 164-177https://doi.org/10.3322/canjclin.55.3.164 Crossref PubMed Scopus (430) Google Scholar to teach trainees how to respond to patient emotions. When used effectively, these skills communicate caring and help patients and families navigate their emotions and cope with their circumstances, both of which ultimately help with decision-making. However, we worry that some learners may not progress beyond this model, and may even see these empathic statements as a tool to get emotions to settle down and let the patient can make the “right” decision. This suggests that we - the teachers - need to do a better job explaining the way that emotions and empathy function in the clinician-patient/family interaction. Emotion and decision-making theory 8 Lerner JS Li Y Valdesolo P Kassam KS. Emotion and decision making. Annu. Rev. Psychol. 2015; 66: 799-823https://doi.org/10.1146/annurev-psych-010213-115043 Crossref PubMed Scopus (1081) Google Scholar ,9 Conte B Hahnel UJJ Brosch T. From values to emotions: Cognitive appraisal mediates the impact of core values on emotional experience. Emotion. 2022; https://doi.org/10.1037/emo0001083 Crossref Scopus (1) Google Scholar , as well as our clinical experiences, lead us to conclude that skilled empathy, beyond resolving emotion so the conversation can move forward, helps us in these discussions in at least four additional ways. Empathy helps us uncover and understand patient values, to appropriately pace the conversation, to facilitate healthy grieving, and, ultimately, transforms how we approach our work. Below we describe these four functions of empathy in an encounter in which we meet with a patient with serious illness or their family to discuss medical decisions. . We focus on the hospital setting, where we meet families in crisis and must build a connection quickly. However, these skills may apply to a wide variety of clinical encounters.

Readmission risk identification: Implementation of a patient-centered interview.

6564 Background: Unplanned 30-day readmissions in the cancer population are common. There are few large studies describing cancer patients’ readmission perspective. To better define predisposing factors associated with readmission, our Nurse Case Manager team implemented a patient-focused survey. Methods: Cancer patients readmitted to The James Cancer Hospital from May 2020-December 2021 were included. Readmission events were defined as an inpatient hospital readmission within 30 days of the patient’s prior hospitalization. Team members conducted a 16-question survey immediately following readmission to evaluate the patients’ perspective on factors that may have contributed to their readmission; results were recorded. Results: A total of 3,333 readmissions were unplanned, 109 planned, 22 listed as other; 3,464 patients completed interviews (Table). During their index admission, most patients reported receiving (90%) and understanding (89%) discharge education/instructions. Upon index discharge, most patients (62%) were discharged on a new medication; the majority reported filling their prescription (95%) and taking it as instructed (98%). Nearly all patients had a post-index hospitalization follow up appointment scheduled, but only 58% reported attending. The primary reason reported for not attending was readmission prior to the appointment. Just over 50% of patients received a post-index hospital stay phone call. Some patients (6% yes; 58% unanswered) felt services at discharge would have been helpful. Most patients (51%) contacted their provider regarding worrisome symptoms experienced prior to being readmitted. Pain (18%), fever (11%), and shortness of breath (10%) were the most commonly reported symptoms that prompted returning to the hospital. Conclusions: To our knowledge, this is the largest study to date of cancer patients’ own perspective of their 30-day readmission. More immediate post-hospitalization follow up and increased deployment of tailored discharge services represent areas of opportunity identified to decrease readmission rates. Symptom-specific interventions may also be impactful. Due to the negative downstream effects readmissions have on the healthcare system, it is critical to develop risk mitigation strategies incorporating patient-reported experience. [Table: see text]

Patient-centred interviewing in Outpatient Departments: A doctor-client perspective

Background: The medical interview is the most common undertaking by a physician. On average, a doctor performs over 200,000 interviews during his career. The traditional medical interview was centred on the clinician. In the late 1970s, the bio-psychosocial model was first introduced by Engel and followed by McWhinneys’ as patient-centred approaches which were swiftly adopted into practice by clinicians. However, in Sri Lanka, no clear evidence could be found to suggest that patient-centredness in the medical interview was given much emphasis in the past. Research evidence available from the local setting on this field is limited. Against this backdrop, it is imperative to assess the perceptions of patient-centred interviewing among the doctors as well as patients.Objective: To assess the doctor and patient perceptions on patient-centred interviewing in Outpatient Departments (OPD) consultations.Methods: A descriptive cross-sectional study was conducted in OPDs of government hospitals in the Colombo Regional Director of Health Services division. All doctors and a sample of patients over the age of 18 years were included. Data collection was done through a self-administered questionnaire and focus group discussions. Data analysis was done by using MS Excel and framework thematic analysis.Results: Both doctors and patients perceived the short consultation time as a leading challenge to have patient-centred interviews in OPDs. In addition, interviewers being disrespectful to patients, providing inadequate information, not getting the involvement of the patient in decision making, and having poor listening skills were negatively perceived by the patients. Overcrowding, heavy workload, stressful work conditions, lack of privacy, and low priority given by the hospital management to OPD functions were perceived by the doctors as barriers to improve the patient-centred interviews. Even though the majority of the doctors have already undergone communication skills training, their willingness to learn and improve these skills was noted.Conclusions and Recommendations: As perceived by the partakers, the patient-centred interviewing in the OPDs has multiple challenges. Placing more emphasis on organizing communication skills training, ensuring longer consultations, providing a more responsive working environment for the doctors, ensuring privacy and confidentiality of transpired information, reformulating OPD functions are recommended.

Locally advanced squamous cell carcinoma with extensive destruction of face

A 58-year-old male with a past medical history of squamous cell carcinoma and basal cell carcinoma presented to the emergency department with complaints of right facial mass, loss of vision, and frequent falls due to visual disturbances. The mass was also associated with pain and purulent drainage. On examination, the patient had a large necrotizing and ulcerative mass occupying the entire right hemiface with complete destruction of facial anatomy including the right eye and nose as shown (Figure 1). On further inquiry, the patient stated that he noticed a “Little Bubble” on his face 3 years ago, which has been progressively worsening since then. He was estranged from his family and had been living alone. The patient did not seek medical care earlier for reasons he did not want to share with the medical team despite our multiple attempts at patient-centered interviewing. He recently established contact with his daughter who ultimately convinced him to seek medical attention. The patient was diagnosed with squamous cell carcinoma and basal cell carcinoma over his face and scalp several years ago, which was successfully treated with surgery at that time. However, he did not follow up and had not seen a physician in several years.

An Advanced Communication Skills Workshop Using Standardized Patients for Senior Medical Students.

IntroductionMedical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students. The workshop emphasized communication skills for four scenarios—strong emotion, goals of care, medical error, and palliative care assessment—and utilized formative peer assessment and feedback.MethodsWe created the four ACSW cases with case-specific communication behavior checklists and a common modified Master Interview Rating Scale in a Capstone Course for senior medical students. In groups of three, students rotated through three of four stations. Each student conducted one of the interviews while the other two completed the checklists and provided verbal feedback. We performed one-way analyses of variance on Likert responses and content analysis on open responses on a post-ACSW survey.ResultsNinety-one students completed the ACSW and survey. Students assigned high value to all four ACSW student roles: interviewer, observer, feedback recipient, and feedback provider. Students rated the experience above average to excellent on nearly all survey items. Open-response themes included “liked the opportunity to give or receive peer feedback” (46%) and “found the checklists helpful” (45%).DiscussionFeasible and well received by senior medical students, our ACSW offers an opportunity to practice and observe advanced communication skills and peer feedback. A peer-assisted, formative learning model, the ACSW efficiently addresses a key aspect of residency preparation.

Making the biopsychosocial model more scientific-its general and specific models.

Some aver that the biopsychosocial (BPS) model is not fully scientific because it lacks a method to produce BPS information. To resolve this criticism, I propose that we think in terms of general and specific BPS models. What most understand to be the model is the general BPS model. It simply indicates that all patients be understood in biological, psychological, and social terms without specifying a method or sources of BPS information. Its fundamental function is to guide medicine away from the effete, 17th century disease-only model in clinical care, teaching, and research. Considerable population-based research data also support its scientific status. Less well understood, but of greater relevance to the clinician, is the specific BPS model, which describes the BPS features unique to an individual patient. The specific model, however, requires an interviewing method to achieve this, the method critics believe lacking. In this article, I review how medical communication scholars have established a method to acquire individualized BPS data on each patient. Research identified the patient-centered interviewing (PCI) method to do this. After much progress over several decades, the field was able to test the PCI in several randomized controlled trials-and confirmed it to be evidence-based. Therefore, by definition, because the patient-centered interview defines the specific BPS model in each patient, the model itself is evidence-based. This means we now can, for the first time, identify a scientific BPS model for every individual patient. Joining this scientific support with much existing data for the general model, we now have a fully scientific BPS model.

The Electronic Health Record Objective Structured Clinical Examination Station: Assessing Student Competency in Patient Notes and Patient Interaction.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

The Relationship between the Timing of a Self-Efficacy Questionnaire, Duration of Training, and Levels of Self-Efficacy with Patient-Centered Interviewing Skills

ABSTRACT There are conflicting findings about the role that timing plays in the administration of self-efficacy questionnaires and the relationships between self-efficacy scores, training, and subsequent demonstration of skills. The current study examined self-efficacy in the context of a training program to educate residents in patient-centered communication skills. Previous research indicates that providers who use patient-centered skills have higher patient satisfaction ratings and their patients show improved physical and psychological health outcomes. 163 residents conducted patient-centered interviews with standardized patients. One group rated their self-efficacy before the interview (n = 85, 52%) and the other group rated it after the interview (n = 78, 48%). Researchers used a validated content analysis coding scheme to measure patient-centered skills in the interviews. There was no significant difference in self-efficacy scores obtained before or after the interview or in the relationship between self-efficacy and objectively coded patient-centered skills in either group. Self-efficacy also did not mediate the relationship between training in patient-centered skills and significantly improved performance of the skills. The findings suggest that timing of self-efficacy questionnaire does not influence subsequent self-efficacy ratings and that demonstrated PCI skills and perceived self-efficacy ratings increase significantly with training. Results imply that self-efficacy requires further study before it can be used as a surrogate for skills performance.

Um roteiro de entrevista clínica centrada na pessoa para a graduação médica

O ensino de habilidades de comunicação clínica na graduação médica encontra nos princípios e componentes do Método Clínico Centrado na Pessoa (MCCP) uma referência importante para a definição de suas competências. No entanto, mesmo tendo contato com o MCCP em sua formação, é frequente que estudantes de medicina recorram à utilização da anamnese tradicional centrada na agenda médica como um roteiro mais seguro para realização de suas entrevistas. Propomos, como uma hipótese para essa dificuldade dos estudantes, a falta de uma tradução do MCCP em um roteiro padronizado de entrevista médica, especialmente para ensino na graduação. Neste relato, a partir de modelos de entrevista clínica centrada na pessoa (ECCP) selecionados da literatura internacional, apresentamos a primeira etapa de um roteiro de ECCP original, adaptado ao cenário brasileiro. O objetivo deste relato é oferecer uma referência de fácil utilização em língua portuguesa e que possa ser aprimorada pelos profissionais envolvidos com o ensino de comunicação clínica na educação superior no Brasil. Estudos empíricos ainda são necessários para endossar uma utilização mais ampla da proposta aqui apresentada.

Using a Medication Plan as a Quality Indicator: Feasibility and Satisfaction Results from an Observational Study

Background Medication adherence remains a challenge for patient management. Changes in the drug regimen after a hospital stay can lead to confusion or misunderstandings. We implemented a structured patient-centered interview during which a computer-generated individualized medication plan was discussed and provided to patients at discharge. Objective To explore whether a medication plan can be a quality indicator, in terms of its content (quality) and its implementation in the resident’s workflow (feasibility). Methods An observational mixed method study with interviews of 174 patients from general internal medicine wards at 1 week and 1 month after discharge, and of 91 physicians at baseline. We report the quality of the medication plan in terms of content and state of completion. We describe feasibility for residents to complete this plan, as well as patient and resident satisfaction with the plan. Results 83% of participants received a medication plan. Physicians verified renal function (83%) to adapt doses but did not regularly assess for medication interactions (43%). Incomplete plans (61%), were due to blanks when physicians considered the information irrelevant for their patients. Error rate was &lt;3%. Patients reported low use of their plan after discharge (64% found it useful after 1 week, whereas only 37% used it when taking their medication 1 week after discharge). Conclusion Although the plans were considered useful by both patients and physicians, their implementation could have been optimized by considering the overall process (creation to patient use). Mobile apps could help fill gaps in supporting patients for medication adherence.

Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered care

Postpartum contraceptive decision making is complex, and recommendations may be influenced by breastfeeding intentions. While biologically plausible, concerns about the adverse impact of hormonal contraception on breast milk production have not been supported by the clinical evidence to date. However, the data have limitations, which can lead providers with different priorities around contraception and breastfeeding to interpret the data in a way that advances their personal priorities. Discrepancies in interpretations can lead to divergent recommendations for individual women and may cause conflict. Furthermore, providers must recognize that decision making about contraception and breastfeeding takes place in complex cultural, historical and socioeconomic contexts. Implicit bias may influence a provider's counseling. Unrecognized biases toward one patient or another, or one practice or another, may influence a provider's counseling. It is crucial for providers to strive to recognize their own biases. Providers need to respectfully recognize each patient's values and preferences regarding hormonal contraception and breastfeeding. Developing a patient-centered decision tool or implementing patient-centered interview techniques specifically around breastfeeding and contraception could help to minimize provider-driven variability in care.

Teaching residents mental health care

ObjectiveWe tested the hypothesis that trained medical faculty can train residents effectively in a mental health care model. MethodsAfter the authors trained medical faculty intensively for 15 months in primary care mental health, the newly trained faculty taught medical residents intensively. Residents were evaluated pre- and post-residency and compared to non-equivalent control residents in another city. Using ANOVA, the primary endpoint was residents’ use of a mental health care model with simulated patients. Secondary endpoints were residents’ skills using models for patient-centered interviewing and for informing and motivating patients. ResultsFor the mental health care model, there was a significant interaction between study site and time (F = 33.51, p < .001, Eta2 = .34); mean pre-test and post-test control group scores were 8.15 and 8.79, respectively, compared to 7.44 and 15.0 for the intervention group. Findings were similarly positive for models of patient-centered interviewing and informing and motivating. ConclusionsTraining medical faculty to teach residents a mental health care model offers a new educational approach to the widespread problem of poor mental health care. Practice ImplicationsWhile the models tested here can provide guidance in conducting mental health care, further evaluation of the train-the-trainer program for preparing residents is needed.

Using Technology to Enhance Teaching of Patient-Centered Interviewing for Early Medical Students.

Effective strategies for teaching communication skills to health professions students are needed. This article describes the design and evaluation of immersive and interactive video simulations for medical students to practice basic communication skills. Three simulations were developed, focusing on patient-centered interviewing techniques such as using open-ended questions, reflections, and empathic responses while assessing a patient's history of present illness. First-year medical students were randomized to simulation or education-as-usual arms. Students in the simulation arm were given access to three interactive video simulations developed using Articulate Storyline, an e-learning authoring tool, to practice and receive feedback on patient-centered interviewing techniques to prepare for their Observed Structured Clinical Examination (OSCE). Trained raters evaluated videos of two OSCE cases for each participant to assess specific communication skills used during the history of present illness component of the interview. Eighty-seven percent of the students in the simulation arm interacted with at least one simulation during the history of present illness. For both OSCE cases, students in the simulation arm asked significantly more open-ended questions. Students in the simulation arm asked significantly fewer closed-ended questions and offered significantly more empathic responses in one OSCE case. No differences were found for reflections. Students reported that the simulations helped improve their communication skills. The use of interactive video simulations was found to be feasible to incorporate into the curriculum and was appealing to students. In addition, students in the simulation arm displayed more behaviors consistent with the patient-centered interviewing model practiced in the simulations. Continued development and research are warranted.

Patient perspectives on emergency department self-referral after bariatric surgery

BackgroundReducing avoidable emergency department (ED) visits is an increasingly important target of quality improvement and cost containment efforts in bariatric surgery. Administrative and clinical registry data provide an incomplete picture of the factors contributing to postoperative ED utilization. Patient-centered interviews can help identify intervention opportunities. ObjectivesWe sought to understand the circumstances surrounding patient self-referral to the ED after elective, primary bariatric surgery. SettingA quality improvement collaborative in Michigan. MethodsA prospective review of clinically abstracted data and patient interviews was completed across 40 hospitals participating in a statewide quality improvement collaborative. Trained nurses collected data on the circumstances surrounding patients’ 30-day postoperative ED visits using a previously validated interview tool. Over a year, 201 of 633 total ED visits met the inclusion criteria, with 78% of those patients being interviewed. ResultsThe most common reported chief complaints were abdominal pain and nausea/vomiting. Patients reported high compliance with provider-driven perioperative measures to reduce ED visits. One third of patients stated urgency as the reason for not contacting their surgeon prior to their visit. A majority of patients believed their ED visit was both necessary and unavoidable. ConclusionsMost patients experienced non-life-threatening symptoms but believed their concerns required immediate medical attention in an ED. Patients did not seek lower acuity alternatives despite the increasing availability of these lower cost options. Urgent care centers are one practical alternative for patients who need expeditious professional evaluation. Focused, patient-centered education and promotion of appropriate lower acuity options may decrease nonurgent ED utilization among postoperative bariatric patients.

The relevance of clinical ethnography: reflections on 10\xa0years of a cultural consultation service

BackgroundTraining health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients’ social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient’s explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the “real-world” context of medical practice may impose barriers to such patient-centered interviewing. Creating opportunities for role modeling and critical reflection may help overcome some of these barriers, and contribute to improved intercultural communication in healthcare.We report and reflect on a retrospective analysis of 10 years experience with a “cultural consultation service” (CCS) whose aim is to provide direct support to clinicians who encounter intercultural difficulties and to model the usefulness of clinical ethnographic interviewing for patient care.MethodsWe analyzed 236 cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation. In addition, we interviewed 51 clinicians about their experience and satisfaction with the CCS.ResultsRequests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. All patients had a migration background, two-thirds spoke French less than fluently. In over half the cases, patients had a high degree of social vulnerability, compromising illness management. Effective communication was hindered by language barriers and undetected or underestimated patient/provider differences in health-related knowledge and beliefs. Clinicians were highly satisfied with the CCS, and appreciated both the opportunity to observe how clinical ethnographic interviewing is done and the increased knowledge they gained of their patients’ context and perspective.ConclusionsA cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.

Some Basic Concepts of Family Medicine Explained by Means of Fables (Part 2 of 2): Patient-Centered Interview, Biopsicosocial Model, Actors and Resources/Strengths of the Patients, and Concept of Health and Disease

Some Basic Concepts of Family Medicine Explained by Means of Fables (Part 2 of 2): Patient-Centered Interview, Biopsicosocial Model, Actors and Resources/Strengths of the Patients, and Concept of Health and Disease

Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country.

Background:Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor–patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor–patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan.Materials and Methods:The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data.Results:The study revealed four emerging themes: (1) Lack of doctor–patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients’ concern with their improvement in health and doctor's demeanor.Conclusion:The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.