What does 'patientcentred' mean in relation to the consultation?

摘要

Background: The phrase 'patientcentred' is frequently used in medical education, and yet has been identified as a 'fuzzy concept'. Focusing on the consultation, this article assists teachers by examining the evolution of the phrase, and then presenting and clarifying a definition. Context: Starting with what is regarded as the first use of the phrase, by Enid Balint in 1969, the evolution of the term is considered with English and North American contributions. Links are made with the development of communication as an important part of the consultation. The information in this article is distilled from a literature review undertaken as part of a qualitative research PhD examining the teaching and learning of patient-centredness. Innovation: Two defining strands are identified and explored in an informed and referenced discourse. The first strand involves the 'discovery of the patient's perspective', where a patient is a person whose disease is experienced individually as an illness, upon which they have thoughts, feelings and expectations of their doctors. The second concerns 'shared control' of the consultation, where a more sharing, participative and equal approach with the patient is adopted. The models of Stewart et at. and Pendleton et at. are compared, and it is shown that although there is common ground, there are different emphases. Implications: Teachers need to be explicit with both meanings of 'patient-centred' to assist learners' understanding and future practice. It is also important to explore the process, content and attitudinal aspects of patient-centredness.