Comprehensive, research-based interviewing guidelines in general practice settings

Abstract

Medical interviewing has evolved considerably during the last 35-50 years. Nowhere has progress been greater than with the articulation of the interview's endpoint, the biopsychosocial model (Engel, 1977b;1980). Interviewers collect personal information and physical symptoms from the patient and, then, synthesize these data to produce a biopsychosocial description -the patient's story. We generally recognize the systems-based biopsychosocial model as the gold standard for understanding the patient from a scientific as well as humanistic vantage point (Simpson, 1963; von Bertalanffy^ 1968;Lorenz, 1971;Brody, 1973;Weiss, 1973;Bateson, 1979;Mayr, 1982). Extensive research supports this position. THE BIOPSYCHOSOCIAL MODEL IS ONLY AS GOOD AS THE PATIENT-CENTERED METHOD USED TO OPERATIONALIZE ITThe biopsychosocial model has not helped as much as once hoped in fostering a humanistic, patient-centered medicine -where patient-centered interviewing practices must be implemented to identify relevant personal and symptom data and to establish an effective provider-patient relationship. The model simply tells us what information we need about the patient without telling us how to acquire it (Smith, 1996;1997). At this time, we understand the biopsychosocial model far better than the patient-centered interviewing process needed to operationalize it.Troublesome in this respect is that many view patient-centered interviewing as time-consuming and Indirizzo per la corrispondenza: Dr. R.C. Smith, B306 Clinical Center, East Lansing, MI 48824 (USA).Fax: + 1-517-432-1326 E-mail: smithrr@pilot.msu.edu difficult to learn, greatly impeding acceptance and implementation. To be certain, mastery of interviewing requires more than the intellectual understanding that suffices with the biopsychosocial model. Experiential learning about usually unfamiliar skills must occur but, as we have shown (Smith et al., 1998), this is not an insurmountable task. Because patient-centered interviewing has progressed more slowly, the original promise of the biopsychosocial model has not been met. In my opinion, this failure occurred, not for a fault in the model but for failure to develop user-friendly and comprehensive patient-centered methods to effectively and efficiently operationalize it. To the extent patient-centered methods are ineffective, the biopsychosocial model remains only a theoretical construct of little practical importance in caring for individual patients on a daily basis. The solution is not to devise new models but, rather, to improve our patient-centered method. PATIENT-CENTERED INTERVIEWING CAN TRANSFORM MAINSTREAM MEDICINE AND VICE VERSAMany recent advances have improved the patientcentered method considerably and include identification of: a curriculum (Lipkin et al

Patient centered approach from general practice to psychiatry

“…II contenuto prevalentemente "psicologico" della consultazione psichiatrica facilmente alimenta l'equivoco che parlare di temi psicologici corrisponda automaticamente all'adozione di un modello "biopsicosociale". Di fatto, sappiamo che l'applicazione di tale modello si qualifica solo nella misura in cui e applicato un approccio "centrato sul paziente" (Smith, 1999), cioe nel modo in cui sono raccolte le informazioni.…”

The importance to teach a biopsychosocial approach to medical interviewing before teaching the recognition of emotional disorders

“…Questa riflessione e soprattutto necessaria quando, come succede nella maggior parte delle Facolta di Medicina in Italia, l'insegnamento dell'approccio olistico alia salute e alia malattia e ad appropriate tecniche di interazione col paziente viene delegato a docenti di psicologia clinica o psicologia medica, perpetuando in questo modo la separazione tra biomedico e psicosociale che lascia allo studente il compito piu difficile dell'integrazione. Smith (1999), nel suo editoriale che appare in questo stesso numero di EPS, evidenzia molto bene i vantaggi che derivano da un insegnamento unificato.…”