SETTING A COMMON GROUND FOR COLLABORATIVE CARE AND CLINICAL INTERVIEWING

Abstract

Background: A relationship and communication matrix and collaborative assessment and care, as part of a set of elicited principles and strategies, are hallmarks of person-centered medicine and health care. Their formulation and cultivation have been predicated on both humanistic and scientific grounds. Objectives: This paper is aimed at articulating the bases, key concepts, and strategies for establishing common ground among clinicians, patient, and family for organizing all person-centered clinical care, starting with clinical interviews. Method: For addressing these objectives, a selective review of the clinical literature was conducted. This was complemented by contrasting the findings with the results of similar papers and reflecting on their implications. Results: One of the broadest and most compelling factors for organizing person centered clinical care effectively in general, and particularly concerning interviewing, assessment, and diagnosis as well as treatment planning and implementation, seems to be setting up common ground among clinicians, patient, and family. Crucial dynamic matrices of common ground seem to be (1) assembling and engaging the key players for effective care, (2) establishing empathetic communication among these players, (3) organizing participative diagnostic processes toward joint understanding of the presenting person’s personhood and health (both problems and positive aspects), and (4) planning and implementing clinical care through shared decision making and joint commitments. Critical guiding considerations for common ground appear to include holistic informational integration, taking into consideration the person’s chronological and space context, and attending to his or her health experience, preferences, and values. Among the most promising strategies for operationalizing common ground is the formulation of a narrative integrative synthesis of clinical and personal information as joint distillation of the assessment process and as foundation for planning care. These considerations also serve as framework for the delineation and organization of effective clinical interviewing. Discussion: These findings are supported, first, by historical and anthropological research, which elucidates health care as part of social cooperation for the preservation and promotion of life. Common ground appears substantiated by the principles of person centered medicine, and represents one of its most clear projections. Also supportive of common ground is recent research on the positive perceptions of clinicians on procedures that are culturally informed and consider personal experience and values. Conclusions: It appears that the establishment of a common ground among clinicians, patient, and family is a critical step for the effective person-centered organization of clinical care in general and for interviewing, diagnosis, and treatment planning in particular.