Description

In the current era of health care reform, our predominantly clinician-centered approaches stand in the way of real system transformation. What could happen if clinicians instead incorporated their patient's story into their appraisal and treatment planning? This document examines such an approach. In order to look more closely at how this could be accomplished in a contemporary primary care clinic, a small test of change was undertaken. Nurses were trained in patient-centered narrative interviewing in order to gather information typically difficult to obtain using a standard medical interviewing format. These nurses were next placed in a variety of healthcare sites. Primary care clinicians (PCCs) in these sites selected patients each clinician felt was frustrating or difficult. The clinician arranged for the nurse to interview these patients. After the interview, the nurse and the PCC discussed the new information provided. The PCC then determined if the information provided was valuable, whether it actually changed their clinical decision-making regarding that patient's diagnosis and treatment, and if their level of frustration with the patient improved.