Teaching Patient-Centered Interviewing for the Patient-Centered Medical Home

NONPF Abstract

A decade ago, two reports published by the Institute of Medicine (IOM) proposed sweeping changes to the way care is delivered in our country; from a provider-driven system to a patient-centered one. The Patient-Centered Medical Home (PVMH) National Demonstration Project was designed to put those recommendations into practice.  The recently-released final report concluded that a transformation to a PCMH was a developmental process and clearly warned that the level of transformation needed much more than new sophisticated office systems. A personal transformation of clinicians would be needed, and this change would require relationship-centered partnerships that went far beyond adherence to clinical guidelines. According to the report, the positivistic, biomedical approach typically employed in primary care settings today is essentially a provider-centered approach. Clinical decision-making requires the collection of data from the patient's symptoms, exam findings, lab tests and other assessments. The individual patient's illness, as the story of suffering or disease as experienced by that person, is not considered data in the biomedical perspective.

However, an evidence-based patient-centered narrative interviewing method puts patient's concerns front and center in the clinical encounter. This presentation will discuss the evidence base for this approach, identify the key components of its practice, and provide examples of instructional methods used to teach this skill to nurse practitioner students.