Fast Fact and Concept #017; Patient-Centered Interviewing: Understanding The Illness Experience

2nd Edition

Author(s): Bruce Ambuel, PhD

Clinical Case: You admit Mary, a new patient, to the hospital. Mary has end-stage, metastatic pancreatic cancer. She has not seen a physician since she was given a terminal diagnosis 6 months ago at another institution. She is nutritionally depleted and has an apparent gastrointestinal obstruction causing significant bloating and discomfort. While you are admitting her she informs you that she is curing herself by drinking fresh fruit and vegetable juices. She refuses to discuss advanced directives because she “Does not trust you.” How might you begin to develop a working relationship with Mary? One strategy is to strive to understand both Mary’s disease and her illness. Disease refers to a biological, pathophysiological process. Illness refers to the patient’s experience. You can assess a patient’s illness experience by asking about 4 dimensions— Feelings, Ideas, Function and Expectations . The acronym FIFE can be a helpful reminder.

F = FEELINGS related to the illness, especially fears

• What are you most concerned about?
• Do you have any specific fears or worries right now?
• I imagine you have had many different feelings as you have coped with this illness.
• Sometimes people have fears that they keep to themselves and don’t tell their doctor.

• What do you think might be going on?
• What do you think this pain means?
• Do you have ideas about what might have caused this illness?

• How has your illness affected you day to day?
• What have you had to give up because of your illness?
• What goals do you have now in your life? How has your illness affected your goals?
• How does this illness affect important people in your life?

• What do you expect or hope I can do for you today?
• Do you have expectations about how doctors can help?
• What do you hope this treatment will do for you?
• What are your expectations about what might happen with this illness?

1. Stewart, M, JB Brown, WW Weston, IR McWhinney, CL McWilliam, TR Freeman. Patient Centered Medicine: Transforming the Clinical Method. Sage Publications, Thousand Oaks, California, 1995.
2. Rosenberg, EE, M Lussier & C Beaudoin. Lessons for clinicians from physician-patient communication literature. Arch Fam Med 1997; 6:279-283
3. Platt FW and Gaspar DL. “Tell me about yourself”: The patient-centered interview. Ann Int Med 2001; 134:1079-1085

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Fast Facts and Concepts #17 Ambuel, B. Patient centered interviewing. 2nd Edition, August, 2005. End-of-Life Palliative Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is use

Creation Date: 6/2000; 2nd Edition, August, 2005

Purpose: Teaching

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