The major purpose of this study was to test the hypothesis that patient-centredness in the consultation was associated with improved patient outcomes. Patient-centred care was defined as care in which the doctor responded to the patient in such a way as to allow the patient to express all of his or her reasons for coming, including: symptoms, thoughts, feelings and expectations. The study took place in the offices of six family doctors. All consultations were audiotaped and the patients completed a questionnaire and two structured interviews with the investigator: one immediately following the consultation and the other two weeks later. Patient-centredness was found to be associated with the doctor having ascertained the patient's reasons for coming and with resolution of the patient's concerns. It was also associated with the patient feeling understood and resolution of the patient's symptoms until confounding variables were controlled. The results of the multivariate analysis suggested that the impact of a patient-centred approach may be part of a package of care, consisting of a doctor whose overall practice allows for the development of personal relationships with patients over time through continuity of care.

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.

This paper presents a method for assessing the doctor-patient interaction in terms of its patient-centredness. Patient-centredness was defined in terms of doctor responses which enabled patients to express all of their reasons for coming, including symptoms, thoughts, feelings and expectations. The method was tested and found to be valid (correlations for criterion validity rs = 0.51 and 0.89), reliable (inter-rater correlation rs = 0.91, intra-rater correlation rs = 0.88), and sensitive, in that it was able to detect differences among doctors (P less than 0.001) and among doctor responses to different patient offers (P less than 0.001). The method was also found to be practical in that it was inexpensive and could be used for a variety of purposes such as by tutors to give feedback to their students, by examiners as part of the evaluation of candidates' consultation skills, and by students and clinicians alike, for self-assessment. The finding that the score for the first two minutes of the consultation correlated highly with the score for the entire consultation (rs = 0.806) greatly increases the time effectiveness of the method, suggesting that it would be practical for use on a large scale, including student assessment and future studies of the relationship between patient-centredness and patient outcomes.

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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