Teaching humanistic and psychosocial aspects of care

Merkel, William T.; Margolis, Ronald B.; Smith, Robert C.

doi:10.1007/bf02602307

Cited by 34 publications

(15 citation statements)

References 27 publications

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“…The 47-item questionnaire was designed based on a literature review and previous surveys (Merkel et al 1990;Rosenzweig 1991;Novack et al 1993), and survey items were reviewed by a group of experts for face validity. Representative questionnaire items and characteristics of the questionnaire are presented in Table 1.…”

Section: Questionnairementioning

confidence: 99%

Pediatric residents’ perceptions of communication competencies: Implications for teaching

Rider

Volkan

Hafler³

2008

Medical Teacher

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Section: Questionnairementioning

confidence: 99%

Pediatric residents’ perceptions of communication competencies: Implications for teaching

Rider

Volkan

Hafler³

2008

Medical Teacher

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“…Indeed, many medical schools still attend poorly to training in interviewing (Novack et al, 1993), many interviewing texts neither reference «patient-centered« nor evince its practice in their recommendations, and many residencies don't effectively broach the topic (Merkel et al, 1990;Parrino & Kern, 1994;Sullivan et al, 1996) -all of which encourage and reinforce an isolated doctor-centered interviewing approach. And all this in light of the well documented benefits from integrating patientcentered and doctor-centered interviewing methods.…”

Section: Patient-centered Interviewing Can Transform Mainstream Medicmentioning

confidence: 99%

Comprehensive, research-based interviewing guidelines in general practice settings

Smith¹

1999

Epidemiol Psichiatr Soc

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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

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“…Instruction in patient education, however, is up against stiff competition for curriculum time. A survey of internal medicine residency programs accredited in 1985-1986 found that only 44% of 434 responding residency program directors reported that their programs offered mandatory training, and only 18% of the programs offered elective training, in patient education-related areas (19). Obstacles cited by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient care costs (37%).…”

Section: Training In Patient Education For Physiciansmentioning

confidence: 99%