Smith’s Patient-Centered Interviewing 4th Edition PDF

Smith’s Patient-Centered Interviewing 4th Edition PDF

In an important series of research and conceptual papers in the 1970s and 1980s, George L. Engel expanded the centuries old (and very successful) biomedical model by demonstrating the importance of psychological and social factors in disease and illness and how these factors affect care processes and outcomes. While patients continue to be understood partly in biological terms, the biopsychosocial (BPS) model underscores the importance of the medical interview in diagnosis, treatment, and therapy by integrating the psychosocial dimensions of the patient and their experience of illness.1–3 Based on General System Theory,3–5 Engel argued that the BPS model could simultaneously make medicine more scientific and more humanistic by incorporating elements of self- and situation/contextual awareness to the interview process.

Shortly after Engel described the BPS model and under the influence of the psychologist Carl Rogers and others,6 Joseph Levenstein, Ian McWhinney, and colleagues7,8 proposed the general concept that clinicians become “patient-centered” in their interviewing approach. Recommendations for patient-centered interviewing included suggestions that the clinician follow the patient’s lead and interests to reach common ground and uncover important psychosocial issues relevant to their care. Other suggestions included inquiry that avoided interruption, and the use of open-ended and nondirective questions. The patient-centered method differed from the standard “clinician-centered” approach that used closed-ended, clinician-directed questions to diagnose and treat diseases. It also differed by asserting that the personhood of the clinician and the patient was key and grounded the relationship in a communication-based conversational context. While the role and expectations of each differed, the biopsychosocial model stressed the importance of mutual influence and reciprocity in building and maintaining healthy, healing clinician–patient relationships.

Francesca C. Dwamena, MD, MS

Professor and Chair
Department of Medicine
Michigan State University
East Lansing, Michigan

Richard M. Frankel, PhD

Professor of Medicine
Department of Internal Medicine
Indiana University School of Medicine
Senior Research Scientist, Center for Healthcare
Information and Communication (CHIC)
Richard L. Roudebush Veterans Affairs Medical Center
Indianapolis, Indiana
Education Institute
Cleveland Clinic
Cleveland, Ohio

Brenda Lovegrove Lepisto, PsyD

Director of Psychosocial Communication
Hurley Medical Center
Assistant Professor of Medicine
Department of Internal Medicine
College of Human Medicine, Michigan State University
Flint, Michigan

Robert C. Smith, MD, MS

University Distinguished Professor
Professor of Medicine and Psychiatry
Division of General Internal Medicine
College of Human Medicine, Michigan State University
East Lansing, Michigan