Approach to the patient
- Jeannette M Shorey, II, MD
Jeannette M Shorey, II, MD
- Professor of Medicine
- University of Arkansas for Medical Sciences College of Medicine
- John J Spollen, III, MD
John J Spollen, III, MD
- Professor of Psychiatry
- University of Arkansas for Medical Sciences College of Medicine
People seek medical services for many different reasons. Medical care for acute or chronic conditions is the principal reason, but patients also request clinicians' advice about maintaining their health, good nutrition, exercise programs, and other strategies to prevent disease. Near the end of life, patients may seek clinicians' advice on withdrawing from cure-oriented interventions, emphasizing the need for comfort and control of symptoms instead. Finally, people come to clinicians for their role as "social managers," seeking assistance in accessing social goods and services (eg, disability benefits, housing benefits, workers' compensation, "permission" to return to work, and clearance to participate in athletic activities). Responding to such diverse needs and requests is a substantial challenge.
As we consider the approach to the "patient," we will focus upon the knowledge, skills, and values that foster effective professional connections with the people who enter clinicians' offices seeking care, some of whom may be sick patients. This topic provides an overview of the approach to the patient, for the satisfaction of the patient and the clinician.
ESSENTIAL TASKS OF THE CONTEMPORARY CLINICIAN
There are six essential tasks of the contemporary clinician (table 1).
●Knowledge base and personal strategies to keep up – Today's clinicians have at their disposal a vast and rapidly-growing body of biomedical and psychosocial knowledge. The understanding and appropriate application of this knowledge is a foundation for effective medical care. Two principal tasks of clinicians are to master the knowledge pertinent to their field of medicine and to develop personal strategies to learn continuously and manage the enormous body of information that will continue to evolve throughout their careers .
●Connecting with patients – The appropriate application of biomedical and psychosocial knowledge requires a contextual understanding of each individual who seeks medical care. This in turn requires the ability to communicate effectively with each patient, mindful of the importance of the person's cultural background. Unfortunately, improvements in communication between clinicians and patients, which would require designated time prioritized to effectively interview patients and understand their needs, has not kept pace with technological advances in medicine . Clinicians must build and sustain trustworthy relationships in order to hear and grasp patient concerns, elicit their requests, negotiate diagnostic and treatment strategies, teach them about their health or illness, check on adherence to treatment plans, and assess the outcomes of interventions. Thus, the third principal task of clinicians is to heed the admonition of E.M. Forster: "always connect" .
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- ESSENTIAL TASKS OF THE CONTEMPORARY CLINICIAN
- FUNCTIONS OF THE MEDICAL INTERVIEW
- Patient education
- EFFECTIVE CLINICIAN STRATEGIES
- Cognitive strategies
- Affective strategies
- Behavioral change strategies
- Social strategies
- DESIRABLE CLINICIAN BEHAVIORS
- PROFESSIONAL VALUES
- Clinical curiosity
- Explicit attention to decision-making preferences
- Attention to cultural issues
- Attention to accountability
- Attention to professionalism
- CONTINUOUS LEARNING
- SUMMARY AND RECOMMENDATIONS