The patient-centred case presentation.
The presentation of case histories is an important part of medical education, socialization and research. The traditional format of presentation, developed at the beginning of the century and based on disease-centred nosologies, has been criticized as minimizing the patient's story and subjective experience. It results in a separation of biological processes from the person. With the development of a patient-centred clinical method, it is desirable to have a patient-centred case presentation format that places the patient's subjective experience in the forefront, without sacrificing traditional biomedical aspects. This paper describes such a method and presents an example. This method is especially useful in the education of senior residents in family medicine, as it can serve to reinforce an attitude of 'patient-centredness'. The method can also serve as a useful bridge between the passive learning inherent in much of the education in medical schools and the active, adult learning necessary for graduate practitioners. By placing an emphasis on the person's subjective experience of illness, rather than solely on the disease, this way of presenting a case history readily suggests new questions and directions in research. The presentation of case histories is an underrecognized tool in family medicine. Changing the format of such presentations to be more consistent with the family medicine world view has implications for education and research.
Department of Family Medicine, University of Western Ontario, London, Canada.
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Freeman
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