Fast Fact and Concept #17: Patient-Centered Interviewing: Understanding The Illness Experience

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Title: Fast Fact and Concept #17: Patient-Centered Interviewing: Understanding The Illness Experience

Author(s): Ambuel, B.; Weissman, D.

This Fast Fact and Concept provides an outline for assessment of a patients'illness experience, not just their disease, through the medical interview. This material is suitable for discussion on ward rounds or as a handout at a teaching conference or communication skills workshop.

Educational Objective(s):
Learn how to assess the illness experience. Understand components of the FIFE interview.
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.

I = IDEAS and explanations of the cause

· 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?

F = FUNCTIONING, the illness' impact on daily life

· 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?

E = EXPECTATIONS of the doctor & the illness

· 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?

Teaching Points:

1. Understanding the patient's illness experience complements but does not replace understanding the disease.
2. Asking FIFE questions takes additional time. As you become experienced you will become more efficient. The time you invest understanding the patient's illness experience can save time later.

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. Rosenberg, EE, M Lussier & C Beaudoin. Lessons for clinicians from physician-patient communication literature. Arch Fam Med, 6:279-283

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Contact: David E. Weissman, MD, FACP Palliative Care Program Director Medical College of Wisconsin (P) 414-805-4607 (F) 414-805-4608 [email protected]

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #17: Patient-Centered Interviewing: Understanding the Illness Experience. June, 2000. End-of-Life Physician 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 used.

Creation Date: 6/2000

Format: Handouts

Purpose: Teaching

Training: 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): Caring for families, Communications skills, Death pronouncement, Discussing hospice care, Family conference, Giving bad news, Negotiating treatment goals, Personal reflection, Prognosis

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).