Patient-Centered Medicine Transforming the Clinical Method Third Edition MOIRA STEWART, JUDITH BELLE BROWN, W WAYNE WESTON, IAN R MCWHINNEY, CAROL L MCWILLIAM AND THOMAS R FREEMAN Radcliffe Publishing London • New York Radcliffe Publishing Ltd St Mark’s House Shepherdess Walk London N1 7BQ United Kingdom www.radcliffehealth.com _____________________________________ © 2014 Moira Stewart, Judith Belle Brown, W Wayne Weston, Ian R McWhinney, Carol L McWilliam and Thomas R Freeman First Edition 1995 (Sage) Second Edition 2003 Moira Stewart, Judith Belle Brown, W Wayne Weston, Ian R McWhinney, Carol L McWilliam and Thomas R Freeman have asserted their right under the Copyright, Designs and Patents Act 1988 to be identified as the authors of this work. Every effort has been made to ensure that the information in this book is accurate. This does not diminish the requirement to exercise clinical judgment, and neither the publisher nor the authors can accept any responsibility for its use in practice. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN 978-190936-803-3 Digital conversion by Vivianne Douglas www.darkriver.co.nz Contents Preface to the Third Edition About the Authors List of Contributors Acknowledgments Part One: Overview 1 Introduction Moira Stewart, Judith Belle Brown, W Wayne Weston, Thomas R Freeman, and Carol L McWilliam 2 The Evolution of Clinical Method Ian R McWhinney Part Two: The Four Components of the Patient-Centered Clinical Method Introduction Judith Belle Brown and Moira Stewart 3 The First Component: Exploring Health, Disease, and the Illness Experience Moira Stewart, Judith Belle Brown, Carol L McWilliam, Thomas R Freeman, and W Wayne Weston “I Don’t Want to Die!”: Case Illustrating Component 1 Judith Belle Brown, W Wayne Weston, and Moira Stewart “I Should Write a Letter to the Editor!”: Case Illustrating Component 1 Carol L McWilliam 4 The Second Component: Understanding The Whole Person, Section 1 – Individual and Family Judith Belle Brown and W Wayne Weston Trauma, Tragedy, Trust, and Triumph: Case Illustrating Component 2 Judith Belle Brown 5 The Second Component: Understanding the Whole Person, Section 2 – Context Thomas R Freeman, Judith Belle Brown, and Carol L McWilliam Mary T: Case Illustrating Component 2 Sonny Cejic and Sara Hahn “Doctor, I Need You to Give Me a Test to Check if I Am a Lesbian”: Case Illustrating Component 2 Darren Van Dam and Judith Belle Brown 6 The Third Component: Finding Common Ground Judith Belle Brown, W Wayne Weston, Carol L McWilliam, Thomas R Freeman, and Moira Stewart “I’d Sooner Take My Chances!”: Case Illustrating Component 3 Jamie Wickett, Judith Belle Brown, and W Wayne Weston 7 The Fourth Component: Enhancing The Patient-Doctor Relationship Moira Stewart, Judith Belle Brown, and Thomas R Freeman When We First Saw Eye to Eye: Case Illustrating Component 4 Clarissa Burke The Flag for Undefined Pain: Case Illustrating Component 4 Gina Higgins Part Three: Learning and Teaching the Patient-Centered Clinical Method Introduction Judith Belle Brown and W Wayne Weston 8 Becoming a Physician: the Human Experience of Medical Education W Wayne Weston and Judith Belle Brown A Messenger: Case Illustrating Becoming a Physician Barry Lavallee and Judith Belle Brown 9 Learner-Centered Teaching W Wayne Weston and Judith Belle Brown Being There: Case Illustrating Being Learner-Centered Christine Rivet and Judith Belle Brown 10 Challenges in Learning and Teaching the Patient-Centered Clinical Method W Wayne Weston and Judith Belle Brown 11 Teaching the Patient-Centered Clinical Method: Practical Tips W Wayne Weston and Judith Belle Brown 12 The Case Report as a Teaching Tool for Patient-Centered Care Thomas R Freeman Margaret L: Case Illustrating a Patient-Centered Case Report Gerald Choon-Huat Koh Part Four: The Health Care Context and Patient-Centered Care Introduction Moira Stewart 13 Team-Centered Approach: How to Build and Sustain a Team Moira Stewart, Judith Belle Brown, Thomas R Freeman, Carol L McWilliam, Joan Mitchell, Lynn Brown, Lynn Shaw, and Vera Henderson The Team was the Container for Her Story: Case Illustrating a Team-Centered Approach Lynn Brown 14 Health Care Costs and Patient-Centered Care Moira Stewart, Bridget L Ryan, and Christina Bodea Part Five: Research on Patient-Centered Care Introduction Moira Stewart 15 Using Qualitative Methodologies to Illuminate Patient-Centered Care Carol L McWilliam and Judith Belle Brown 16 Evidence on the Impact of Patient-Centered Care Moira Stewart 17 Measuring Patient Perceptions of Patient-Centeredness Moira Stewart, Leslie Meredith, Bridget L Ryan, and Judith Belle Brown 18 Measuring Patient-Centeredness Judith Belle Brown, Moira Stewart, and Bridget L Ryan 19 Conclusions Moira Stewart References Preface to the Third Edition The principles underpinning the patient-centered clinical method remain constant but the components have changed: there are now four components instead of six. “Being Realistic,” one of the previous components, was considered not to be part of clinical care and so its material on time and teamwork was moved to other parts of the book. “Prevention and Health Promotion,” the second of the previous components to be changed, was considered to be incorporated into each patient-clinician interaction and therefore has become part of the other components. Conceptual clarity has been achieved regarding where Health Promotion fits in patient-centered care and where Prevention fits (see Chapter 1 ). The teaching and learning chapters comprise an up-to-the-minute compendium of the relevant education literature and methods. The research chapters illuminate patient-centered concepts through stories of lived experiences, and they also provide clear, positive, and uplifting messages about the important impact of patient-centered clinical care. This book is divided into five parts. Part One contains an introduction to the patient-centered clinical method, including its evolution and relationship to other models of care. In addition, common misconceptions about the meaning of patient-centeredness are elucidated. The second chapter in this part is a historic perspective written by Ian R McWhinney. Part Two describes the four interactive components of the patient-centered clinical method. Chapters 3–7 elaborate in detail Components 1–4, respectively. The clinical reader will notice the cases illustrating each of the four components of the patient-centered approach that are embedded in Chapters 3–7. Those most interested in the application of patient-centeredness in everyday practice might enjoy reading the cases first. As McWhinney (2001: 88) has wisely noted, “An actual case brings things alive for us in a way that aggregated data cannot do.” Taken together, the cases represent a typical series of patients in the practice of a busy doctor. All the cases are based on actual clinical encounters; however, the names, dates, and places have been altered to ensure the confidentiality of the participants. Part Three, on teaching and learning, contains five chapters. Chapter 8 examines the experience of medical education. The parallel between the learner- centered method of medical education and patient-centered practice is described in Chapter 9 . Practicing, learning, and teaching patient-centered medicine has