More than 30 years of research have confirmed the value of integrating patient-centered and clinician-centered interviewing skills into most encounters, a few of which studies are summarized here.

Teachers, scholars, and researchers have advanced the field by identifying three functions of the clinical interview;1,2 refining patient-centered definitions;3 acknowledging the role of nonverbal communication;4,5 pinpointing the shortcomings of isolated disease-oriented interviewing;6 demonstrating the key components of the clinician-patient interaction;7,8 identifying interviewers’ negative responses to patients;9,10 demonstrating the principles11–14 and effectiveness of teaching biopsychosocial-patient-centered medicine;15–19 integrating patient-centered principles into treatment20–22 and prevention;23 exploring specific patient-centered approaches24,25 and alternative theories;26 critically reflecting on the biopsychosocial model;27,28 going beyond the dyadic interaction to other relational aspects of medical care;29–31 the important role of qualitative approaches in clinical research32,33 and linguistic study;34 the need for evidence-based interviewing;35,36 and connecting patient-centeredness with health outcomes, albeit with mixed results.37–40

In this chapter, we synthesize the argument for adopting patient-centered, biopsychosocial practices in lieu of a strict biomedical approach.

Most students recognize the powerful humanistic rationale for integrating patient-centered principles as giving them tools to respond to patients’ biological, psychological and social needs. Responding in this way allows us to hear and understand our patients in a way that validates them as human beings rather than as objects of study.41 As we strengthen our patients’ involvement, sense of self-sufficiency, and feelings of responsibility, they are more likely to be self-actualizing,42 an essential feature of positive patient outcomes.30 Thus, effective communication involves a patient who is the expert on her/his needs and a clinician who is the expert at translating these needs into mental and physical disease diagnoses and their treatment.42–44

Clinicians also benefit from a biopsychosocial/patient-centered approach. They report that the approach allows them to more fully embody such human qualities as respect, empathy, humility, and sensitivity. Because these qualities seemed less valued during their training, physicians of the past often felt guilty in expressing them if they were observed doing so, asking colleagues to “not tell anyone.” The idea of developing meaningful relationships and feelings of connectedness with patients, which was discouraged until the latter part of the twentieth century, has now been shown to have a variety of positive benefits45,46 for patients and clinicians both.39,46,47

Integrating patient-centered interviewing skills is more scientific than isolated clinician-centered interviewing.

1. 
   

   Deficiencies of a solely clinician-centered approach.

   
   
   
   
   
   
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      Physicians do not allow patients to complete their opening statement of symptoms and concerns in 69% of visits, interrupting patients after a mean time of 18 seconds.6

   
   
   
   
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      Clinician-centered interviewing elicits only 6% of the primary problems that were ultimately determined to be psychosocial.48

   
   
   
   
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   Superior results from integrating patient-centered skills with clinician-centered ones.

   
   
   
   
   
   
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      Many studies show increased patient satisfaction when patient-centered skills are included, as compared to isolated clinician-centered ones.7,39,47,49

   
   
   
   
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      Patient-centered approaches enhance patient adherence7,47,50 and patients’ knowledge and recall.7,39,47

   
   
   
   
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      Studies also show decreased malpractice suits51–53 and decreased doctor shopping54 when clinicians integrate patient-centered skills.

   
   
   
   
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      Improved health outcomes have been reported when clinicians use patient-centered skills. For example, patient-centered approaches lead to better blood pressure and diabetic control,55,56improved perinatal outcomes,57shortened and less complicated postoperative courses,58–60and improved cancer outcomes.61–68 Several reviews have summarized the benefits to patients and clinicians.30,49,69

   
   
   
   
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      In addition, patient-centered interviewing efficiently elicits much of the physical symptom data previously obtained via clinician-centered inquiry70—and it adds physical symptom information not elicited at all by clinician-centered approaches.71 Sir William Osler captured this best in 1910, “Listen to the patient, he is telling you the diagnosis.”72

   
   
   
   
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   Integrating patient-centered interviewing skills is more compatible with general scientific principles.

   
   
   
   
   
   
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      An isolated clinician-centered approach produces biased data about the patient. This is at odds with the basic scientific requirement that data about the subject of any science be reliable (consistent, unbiased).73–75 Experience shows that patient-centered interviewing is more consistent and less biased because it is far less influenced by the interviewer.44

   
   
   
   
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      Patient-centered interviewing elicits personal and emotional information that is not obtained by isolated clinician-centered interviewing76–78 and fulfills the scientific requirement that data about the subject of any science be valid (complete, fully representative).73–75 By including psychosocial aspects of the patient, an integrated approach demonstrably produces more complete and, therefore, more valid data about the patient—who is, after all, the subject of the science of medicine.6,44,48,79–82

   
   
   
   
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      Not only are data more reliable and more valid, but patient-centered interviewing skills also produce a biopsychosocial description of the patient rather than a simple disease description. Biopsychosocial medicine stems from general system theory, which superceded the simple cause-effect model83–85 responsible for the disease-oriented biomedical model.

   
   

An additional attribute of patient-centered interviewing skills is that they help clinicians to efficiently determine the most important problem the patient has at a given time.44,86 Also importantly in the modern era of medicine where throughput dominates, research has shown that integrating patient-centered skills takes no more time than a solely clinician-centered approach.87