The language of attentive patient care

Mishler, Elliot G.; Clark, Jack A.; Ingelfinger, Joseph A.; Simon, Michaël

doi:10.1007/bf02597407

Cited by 57 publications

(9 citation statements)

References 9 publications

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“…Central to this model is a distinction between disease and illness. Several others, including Engel (1979), have made a similar distinction (Benner & Wrubel, 1989;Cassell, 1985Cassell, , 2004Fabrega, 1974;Helman, 1981;Kleinman, 1988;Lipkin, 1987;Mishler, 1984, Mishler, Clark, Ingelfinger, & Simon, 1989Taylor, 1979;Toombs, 1987Toombs, , 1992Toombs, , 2001Williams & Hadler, 1983;), and we believe this common feature lends validity to the concept. Disease is an abstraction, the thing that is wrong with the body-as-machine; it is expressed in terms of altered anatomy or pathophysiology.…”

Section: Espite Widespread Interest In Andsupporting

confidence: 64%

Patient-centered medicine: A guide to the biopsychosocial model.

Weston¹

2005

Families, Systems, & Health

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Physicians find the biopsychosocial model appealing but difficult to implement. Application of the model is hampered by the conventional clinical method, which demands uniformity and comprehensiveness. To avoid being overwhelmed, physicians narrow their task by concentrating on the biological dimensions of sickness. To broaden their approach-to include psychological and social aspects of illness-physicians need a transformed clinical method, one in which they seek as much to understand patients' experiences of illness as they do to make a diagnosis. Cues presented by patients guide physicians to the aspects of their problems that demand the most attention. This approach is more appropriate than the conventional clinical method for broad-based disciplines such as family medicine.

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Section: Espite Widespread Interest In Andsupporting

confidence: 64%

Patient-centered medicine: A guide to the biopsychosocial model.

Weston¹

2005

Families, Systems, & Health

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“…• Demonstrating genuine concern through the expression of curiosity (Jagosh et al, 2011) • Listening attentively to patients' presentations and noting special concerns underlying patients' narratives (Mishler, Clark, Ingelfinger, & Simon, 1989) • Conducting the physical examination thoughtfully, consciously applying touch and observing patients' reactions (Verghese, 2009;Verghese, Brady, Kapur, & Horwitz, 2011) • Observing with sensitivity ambient feelings, both those expressed by patients as well as those experienced by oneself (Halpern, 2003) • Considering carefully the use of words and time in the creation of appropriate therapeutic agendas (Coulehan et al, 2001;Mauksch, Dugdale, Dodson, & Epstein, 2008) 6…”

Section: Interpersonal Skillsmentioning

confidence: 99%

Shared presence in physician-patient communication: A graphic representation.

Ventres¹,

Frankel²

2015

Families, Systems, & Health

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Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care-all deceptive in their simplicity but, in fact, highly complex-or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physicianpatient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients.

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“…Where Habermas talks about the ‘system’, Mishler refers to the ‘system of technological medicine’ that is based on a bioscientific model and uses strategic action to maintain its power. In the medical encounter the patients' needs and requests can be understood either in the context of their experiences, the events in their life, what he calls the ‘voice of the lifeworld’ (Mishler et al , 1989, p. 327) or by using the technical ‘voice of medicine’, which interferes with the patient's meaningful accounts. Examples of two different approaches to the medical interview are offered (Mishler et al , 1989): the attentive interview, characterized by attentive questioning and listening, and the ‘unremarkable’ interview, during which doctors:…”

Section: The Balint Traditionmentioning

confidence: 99%

Reflexivity in the medical encounter: contributions from post‐modern systemic practice

Ingrassia

2011

Journal of Family Therapy

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In this article, I attempt to identify the forms of reflexivity that take place in the medical encounter and the possible contributions that the understanding of reflexivity in systemic thinking can make to medical practice. I start by reviewing some of the literature on the doctor–patient relationship as the necessary foundation to think about and understand reflective practice in medicine. I then argue that, as the medical profession comes under scrutiny from a variety of different individuals and groups, as well as from itself, a process of reconciliation between modern and postmodern thinking, as it has been suggested in the systemic literature, might help get a better grasp of the complex predicament and dilemmas of doctors in modern society. The notion of reflexivity, the ability of any system to critically think about itself by promoting a conversation between the experts and the subject of their expertise is probably the essence of the critical momentum of postmodernism and should be an essential professional attribute for all doctors.

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The language of attentive patient care

Cited by 57 publications

References 9 publications

Patient-centered medicine: A guide to the biopsychosocial model.

Patient-centered medicine: A guide to the biopsychosocial model.

Shared presence in physician-patient communication: A graphic representation.

Reflexivity in the medical encounter: contributions from post‐modern systemic practice

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