The Medical Interview: Clinical Care, Education, and Research PDF
Preview The Medical Interview: Clinical Care, Education, and Research
Frontiers of Primary Care Series Editor: Mack Lipkin, Jr. Frontiers of Primary Care Series Editor: Mack Lipkin, Jr. Editorial Board Charles Bridges-Webb Sydney, Australia Thomas Delbanco Boston, Massachusetts, USA Sheldon Greenfield Boston, Massachusetts, USA Henk Lamberts Amsterdam, The Netherlands Robert Pantell San Francisco, California, USA Burton Singer New Haven, Connecticut, USA Robert Taylor Portland, Oregon, USA Kerr L. White Stanardsville, Virginia, USA Maurice Wood Richmond, Virginia, USA Mack Lipkin, Jf. Samuel M. Putnam Aaron Lazare Editors The Medical Interview Clinical Care, Education, and Research J. Gregory Carroll Richard M. Frankel Associate Editors Allen Keller Terri Klein P. Kay Williams Assistant Editors Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest Mack Lipkin, Jr., M.D., Department of Medicine, Division of Primary Care, New York University Medical Center, 550 First Avenue, New York, NY 10016, and American Academy on Physician and Patient, 550 First Avenue, New York, NY 10016, USA Samuel M. Putnam, M.D., East Boston Neighborhood Health Center, 10 Grove Street, East Boston, MA 02128, USA Aaron Lazare, M.D., University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA With 5 Illustrations Library of Congress Cataloging-in-Publication Data Lipkin, Mack, 1943- The medical interview/Mack Lipkin, Jr., Samuel M. Putnam, Aaron Lazare. p. cm. Includes bibliographical references and index. ISBN-13: 978-1-4612-7559-6 e-ISBN-13: 978-1-4612-2488-4 DOl: 10.1007/978-1-4612-2488-4 1. Medical history taking. I. Putnam, Samuel M. II. Lazare, Aaron,1936- . III. Title. [DNLM: 1. Medical History Taking-methods. 2. Physician-Patient Relations. WB 290 L764m 1994] RC65.L57 1994 616.07'51-dc20 DNLMIDLC for Library of Congress 94-6511 Printed on acid-free paper. © 1995 Mack Lipkin, Jr., M.D. Softcover reprint of the hardcover 1s t edition 1995 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of Dr. Lipkin or his designee (N.Y.U. Medical Center, 550 First Avenue, New York, NY 10016, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden without written permission. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production coordinated by Chernow Editorial Services, Inc., and managed by Natalie Johnson; manufacturing supervised by Jeffrey Taub. Typeset by Asco Trade Typesetting Ltd., Hong Kong. 98765 432 1 This book is dedicated to clinicians of all disciplines who are committed to learning and teaching themselves and their students how to form more effec tive relationships with patients. As individuals, they have labored long and hard, often in isolation, to teach the medical interview. As a group, as sembled in the American Academy on Physician and Patient, they have provided the inspiration for this book. Many who read this book will recognize ideas that they helped to nourish. We acknowledge with appre ciation each person who feels a special sense of ownership. We also dedicate this book to our families with love and gratitude for their love, support, and acceptance of the long effort this book has required. We thank you Anna Rose and Ellen; Donka, Aleisha, and Laura; Louise and Robert, Jackie, David, Sam, Sarah, Hien, Thomas and Naomi. Series Preface Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a posi tive and caring personal relationship, care by a single healthcare pro vider for the majority of the patient's problems, coordination of all care by the patient's personal provider, advocacy for the patient by the pro vider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminish ing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly. They have become viable alternatives to the specialty approach to care with its potential dehumanization, coordination problems, and increased cost. The primary care disciplines have begun to create new sets of intel lectual tools and new educational approaches to support their new para digm of biopsychosocial care, including clinical epidemiology that exam ines the efficacy, effectiveness, and efficiency of everyday real-world care; clinical decision making that is beginning to find ways to improve the rational basis for common clinical choice; the medical interview, which is in this volume coming under critical study as the major medium of care; problem-based learning and community-oriented medical education that enable efficient learning of the greatest relevance and with increased satisfaction for learner and teacher; and the philosophic and empiric study of ethical aspects of care. Several major questions have emerged in the new disciplines. Who is to do primary care? What do these practitioners need to know? How can the needed content, skills, and attitudes be best taught? Who is to teach VB viii Series Preface these new practitioners, and what skills do the practitioners need? Per sons interested in these questions include primary care professionals, teachers, and researchers in primary medicine. Frontiers of Primary Care plans to help meet the needs of these over lapping groups, reporting fundamental and applied research findings in clinically relevant, readable ways. It will provide information to teachers of primary medicine about necessary content areas such as alcoholism or the medical interview. It will teach teachers about new teaching ap proaches and methods and include some books teachers may choose to use as texts. Finally, it will publish new conceptual work about the basis of the field and the shifting paradigm of care. This volume is the first type of contribution to the series. It is an impor tant introduction for health care teachers, practitioners, and those pre paring for such roles concerning the doctor/patient relationship and the medical interview. It is the first empirically based, scholarly reference text in this new field. The data and approaches give us hope for the future humanism and relevance of health care. Mack Lipkin, Jr., M.D. Series Editor Preface Medical interviewing is a core clinical skill. It is the medium of doctor/ patient communication and relationship, the most important single source of diagnostic data, the means through which we elicit the patient's partnership and participation in the processes of care. An average gen eralist during a 40-year professional life may conduct between 160,000 and 200,000 interviews! It is not clear what the early history of the medical interview con tains-data available are scanty and indirect. Most of what is available consists of practitioner recall of the content or themes of encounters. Only during and after World War II did recordings begin to be taken that can be reviewed for study and scientific description. A few authors attempted to describe their own approach to interviewing and to obtain ing the desired content of an encounter between practitioner and patient. In the 1960s, videotaping became significantly more convenient and affordable. Barbara Korsch videotaped the encounters between pediatri cians and their patients in an emergency room in Los Angeles. Her ana lysis of these interactions led to the description of communication gaps. Suddenly, tools were developed for the systematic study of our most fun damental clinical tool. Since Korsch, we have seen snowballing quantities of research and scholarship concerning the medical interview and related skills. There now exists an increasingly robust literature on the medical interview that includes more than 7,000 titles. There is a raft of introduc tory texts. There is a quarterly newsletter, Medical Encounter. This book was undertaken to draw together some of the wealth of re search and scholarship concerning the medical interview over the last 25 years and in so doing provide some structure to the large domain of knowledge concerning the medical interview and related skills. To our knowledge, this has not been undertaken previously with such a large scope-most of the existing textbooks are focused at beginning clinical students. We have attempted to coalesce the findings and progress of the 1970s through the early 1990s into readable segments. Although it is all of in- ix x Preface terest to us, we recognize that readers may prefer to emphasize reading of selected parts. A teacher might look to the education segment (part VI). The researcher or persons considering entering research might find part VIII a useful introduction to the concepts currently under scientific scrutiny. We hope that clinicians at every stage will find use in the clinical sections of the book, which provide a framework for the interview (part I), the structure and process of the interview (part II), the context of the inter view (part III) and special situations and types of interviews (part IV). The book begins with general aspects of the interview, focuses then on specific situations and types of interviews, and then covers ethics, teach ing, evaluation, research, and resources. In the process of writing, we asked authors to relate their discussion to the three-function model of the interview, presented here by Lazare, Putnam, and Lipkin but originated by Bird and Cohen-Cole. Our hope is that use of the three-function model will assist in reading, remembering, and teaching. The impetus for this book arose in the work of the Task Force on the Doctor and Patient of the Society of General Internal Medicine. The Task Force was founded in 1978 to pursue research, education, and faculty de velopment of generalists in the medical interview and related skills. It has involved internists, family practitioners, pediatricians, psychiatrists, social scientists, and psychologists, other physicians, nurses, and social workers. Over time, the Task Force developed highly successful faculty develop ment courses using an innovative model created by Dr. Lipkin and started a newsletter now reaching 1,500 readers, Medical Encounter, edited by Dennis Novack. The Task Force did collaborative research, held annual research symposia, and supported those in or considering this area of learning and teaching. Because the demand for the courses was so high, the Task Force in 1990 obtained federal funding for training facilitators, directed by Craig Kaplan. This has now become a national fellowship allowing persons at several stages of development to find guided evolution as scholars and teachers of the medical interview. In 1992, the Task Force became the American Academy on Physician and Patient, a national academy dedicated to furthering work in this field and welcoming persons from diverse disciplines, including especially pediatrics, family medicine, internal medicine, psychiatry, psychology, and social sciences. In 1982 the Task Force created a curriculum committee, headed by Rudy Napodano. This committee defined a core curriculum (see Lipkin, Quill, and Napodano, 1984) and noted the lack of generally available re sources for clinicians, teachers, and researchers. Hence the committee called for creation of this book. The vision of those involved in the ori gins of this work is much appreciated. Certain individuals have played key roles in bringing this book to press. Foremost are our associate edi tors: J. Gregory Carroll and Richard M. Frankel; our assistant editors Allen Keller, Terri Klein, and P. Kay Williams. They have our deep gratitude. Preface xi P. Kay Williams and Terri Klein patiently managed administrative aspects of the gestation. Of course, the authors have worked intensely hard, been very patient with our editorial whims, and been generously giving of thought and effort. We are most grateful to them. Participants in American Academy on Physician and Patient courses have regularly given invaluable feedback about the appropriateness of our choices for content as well as specific feedback about particular chapters. Finally, our editors at Springer-Verlag have been our champions and advocates throughout this process. We thank them, especially Esther Gumpert and Laura Gillan. Natalie Johnson and Kathy Jackson have been of great help during production. Mack Lipkin, Jr. New York, NY Samuel M. Putnam Boston, MA Aaron Lazare Worcester, MA
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