In the current era of health care reform, our predominantly
clinician-centered approaches stand in the way of real system
transformation. What could happen if clinicians instead incorporated
their patient's story into their appraisal and treatment planning? This
document examines such an approach. In order to look more closely at how
this could be accomplished in a contemporary primary care clinic, a
small test of change was undertaken. Nurses were trained in
patient-centered narrative interviewing in order to gather information
typically difficult to obtain using a standard medical interviewing
format. These nurses were next placed in a variety of healthcare sites.
Primary care clinicians (PCCs) in these sites selected patients each
clinician felt was frustrating or difficult. The clinician arranged for
the nurse to interview these patients. After the interview, the nurse
and the PCC discussed the new information provided. The PCC then
determined if the information provided was valuable, whether it actually
changed their clinical decision-making regarding that patient's
diagnosis and treatment, and if their level of frustration with the
patient improved.