Table 1.

Patient-centered Method for Communication and PPR

STEP 1: Setting the stage for the interview

1. Welcome the patient

2. Use the patient's name

3. Introduce self and identify specific role

4. Ensure patient readiness and privacy

5. Remove barriers to communication

6. Ensure comfort and put the patient at ease

STEP 2: Chief complaint/agenda-setting

1. Indicate time available

2. Indicate own needs

3. Obtain list of all issues patient wants to discuss, e.g., specific symptoms, requests, expectations, understanding

4. Summarize and finalize the agenda; negotiate specifics if too many agenda items

STEP 3: Opening the HPI

1. Open-ended beginning question

2. “Nonfocusing” open-ended skills (attentive listening): silence, neutral utterances, nonverbal encouragement

3. Obtain additional data from nonverbal sources: nonverbal cues, physical characteristics, autonomic changes, accouterments, and environment

STEP 4: Continuing the patient-centered HPI

1. Obtain description of the physical symptoms (focusing open-ended skills)

2. Develop the more general personal/psychosocial context of the physical symptoms (focusing open-ended skills)

3. Develop an emotional focus (emotion-seeking skills)

4. Address the emotion(s) (emotion-handling skills)

5. Expand the story to new chapters (focused open-ended skills, emotion-seeking skills, emotion-handling skills)

STEP 5: Transition to the doctor-centered process

1. Brief summary

2. Check accuracy

3. Indicate that both content and style of inquiry will change if the patient is ready

Adapted from RC Smith, Patient-centered Interviewing: An Evidence-based Method. Lippincott Williams and Wilkins; 2002.

PPR, provider-patient relationship; HPI, history of the present illness.