Patient-centredness has been shown to be associated with improved patient outcomes in the West. The objectives of this study were: (i) to further test a specific method for measuring patient-centredness that had previously demonstrated validity and reliability, and (ii) to test the effectiveness of a patient-centred approach amongst poor, non-Western people in South Africa. Patient-centredness was measured in terms of the practitioner's facilitation of the patient's reasons for coming, including symptoms, thoughts, feelings, and expectations. The study involved nurse practitioners and medical doctors in three primary care settings with patients from eight language groups. The method for measuring patient-centredness was found to be valid, reliable (inter-rater correlations, rs = 0.95, 0.88, and 0.87), sensitive, and practical, being inexpensive, time efficient, suitable for consultations involving interpreters, and not requiring transcripts. The score for the first 2 minutes of the consultation correlated highly with the score for the entire consultation (rs = 0.92), which could make the method useful on a large scale. Patient-centredness itself, was also time effective, applicable to cross-cultural consultations involving interpreters, and was associated with patients feeling understood (P = 0.03), patient-practitioner agreement (P = 0.049), symptom resolution (P = 0.01), and concern resolution (P = 0.006). This study supports the effectiveness of patient-centred interviewing in a non-Western setting as well as this method of assessing it.

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.

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AimThe aim of the study was to describe the characteristics of volunteers who remained active in the home-based care project located in Tzaneen (Limpopo Province) and thereby assist the project leaders to improve the recruitment and quality of the service in the future.