The Three-Function Model of the Medical Interview

Bird, Julian; Cohen-Cole, Steven A.

doi:10.1159/000418260

Cited by 86 publications

(59 citation statements)

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“…These represent the basic functions of the interview. [18][19][20] Model 1 will be involved as part of virtually all interactions and all treatment interventions. Model 2 is more specific to situations where informing and motivating the patient are additionally required and where sharing decisions is key.…”

Section: Discussionmentioning

confidence: 99%

“…The biopsychosocial model (BPS) was articulated by Engel only in the late 1970s, 11,12 followed shortly by general descriptions of patient-centered approaches by McWhinney, 13 followed in turn by wide-scale promulgation of patient-centered practices by what are now called the American Academy on Communication in Healthcare, 14 the European Association for -as well as many other groups including several primary care organizations. Considerable research success also has followed in areas such as a systems approach to medicine, 11,12,17 identifying the functions of the interview, [18][19][20] pinpointing the shortcomings of isolated disease-oriented approaches, 21 demonstrating the key components of the provider-patient interaction, 22 and beginning to show some impact on health outcomes. 22,23 Many experts in the field, though, remain restive and are pushing for further outcomes-based research.…”

Section: Introductionmentioning

confidence: 99%

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Behaviorally Defined Patient-Centered Communication—A Narrative Review of the Literature

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Behaviorally Defined Patient-Centered Communication—A Narrative Review of the Literature

et al. 2010

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“…Residents described changes to every stage of their workflow, from researching the patient's history in the medical record, through post-admission consults. There are multiple published tools and frameworks for each aspect of the initial patient interaction, from the pre-interview chart biopsy, 20,21 to the interview itself, 4,6,7,22,23 to the verbal handoff [24][25][26][27] and consult request. [28][29][30][31] The open-ended comments in this study demonstrate that residents found the CPI to be a useful framework for each stage of the process, indicating that this structure can facilitate patient care through the entire patient interaction with the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The patient interview is perhaps the most common and essential clinical task a physician performs, and an effective interview must balance a variety of different purposes. Physicians work to establish rapport and build a relationship, 4 while also obtaining essential medical information, 5 assessing and understanding the patient, 6 detecting psychosocial problems, 7 and facilitating patient adherence. 8 To accomplish all of these goals in a patient-centered fashion, students and house staff are frequently taught to take and write the patient history in the form of a prose narrative.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

et al. 2016

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BACKGROUND: Patient history-taking is an essential clinical skill, with effects on diagnostic reasoning, patient-physician relationships, and more. We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness (CPI), to guide the initial patient interaction. OBJECTIVE: To determine the feasibility and impact of the CPI on the patient interview, written notes, and communication with other providers. DESIGN: Internal medicine residents used the CPI during a 2-week night-float rotation. For the first week, residents interviewed, documented, and presented patient histories according to their normal practices. They then attended a brief educational session describing the CPI, and were asked to use this method for new patient interviews, notes, and handoffs during the second week. Night and day teams evaluated the method using retrospective prepost comparisons. PARTICIPANTS: Twenty-two internal medicine residents in their second or third postgraduate year. INTERVENTION: An educational dinner describing the format and potential benefits of using the CPI. MAIN MEASURES: Retrospective pre-post surveys on the efficiency, quality, and clarity of the patient interaction, written note, and verbal handoff, as well as open-ended comments. Respondents included night-float residents, day team residents, and attending physicians. KEY RESULTS: All night-float residents responded, reporting significant improvements in written note, verbal sign-out, assessment and plan, patient interaction, and overall efficiency (p < 0.05). Day team residents (n = 76) also reported increased clarity in verbal sign-out and written note, improved efficiency, and improved preparedness for presenting the patient (p < 0.05). Attending physician ratings did not differ between groups. CONCLUSIONS: Resident ratings indicate that the CPI can improve key aspects of patient care, including the patient interview, note, and physician-physician communication. These results suggest that the method should be taught and implemented more frequently.

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“…To construct the TMIRS, first we reviewed medical interview textbooks to identify medical interview behaviors (Bird and Cohen-Cole 1990). We then invited five Japanese experts in the teaching of medical interview behaviors and patient-physician communication to join the item development group, including three family physicians, a general internist, and a behavioral scientist.…”

Section: Measurementsmentioning

confidence: 99%

Identifying Medical Interview Behaviors that Best Elicit Information from Patients in Clinical Practice

Takemura

Atsumi

Tsuda

2007

Tohoku J. Exp. Med.

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Many textbooks indicate the desirability of using specific medical interview behaviors to obtain information from patients, although little evidence has been presented. The aim of this study is to investigate the relationships between the use of medical interview behaviors and the amount of information obtained. The behaviors studied included: open-ended questions, facilitation (comments or interviewer behavior that encourages the patient to continue talking), the open-to-closed cone (the gradual narrowing of focus from an initial nondirective approach to a more direct exploration), summarization (providing the patient with an explicit verbal summary of the information gathered thus far), and surveying problems. The subjects were 315 patients who visited an outpatient facility. These medical interviews were videotaped and reviewed by a trained rater using the Takemura Medical Interview Rating Scale, which was developed to assess the use of particular medical interview behaviors and to measure the amount of information obtained from patients regarding their chief physical complaints. Significant positive relationships were found between three particular interview behaviors and the amount of information obtained: facilitation, the open-to-closed cone, and summarization. These positive relationships were still present after adjusting for other medical interview behaviors used, and after adjusting for the time duration of the medical interviews (F = 15.3, p < 0.0001; F = 40.1, p < 0.0001; F = 5.57, p = 0.019, respectedly). This study reveals a positive relationship between three specific medical interview behaviors (facilitation, the open-to-closed cone, and summarization) and the amount of information obtained in a real clinical practice setting.

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The Three-Function Model of the Medical Interview

Cited by 86 publications

References 0 publications

Behaviorally Defined Patient-Centered Communication—A Narrative Review of the Literature

Behaviorally Defined Patient-Centered Communication—A Narrative Review of the Literature

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

Identifying Medical Interview Behaviors that Best Elicit Information from Patients in Clinical Practice

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