Explanatorymodels in Practice

Health emphasises inequities in care across ethnic groups in the UK. This, coupled with the Royal College of Psychiatrists’ resolve to address concerns about institutionalised racism, promises a fundamental change in existing clinical practice. Practitioners are undecided about the best way to achieve such change. It is over a decade since socio-anthropological methods were recommended as one way of improving the cultural capabilities of practitioners (Kleinman, 1988). People explain their distress in a multitude of ways, often blaming social circumstances, relationship problems, witchcraft or sorcery, or a broken taboo (Weiss, 1997). Kleinman recommended that a patient’s explanatory models of illness should be elicited using a mini-ethnographic approach that explored their concerns: ‘Why me?’ ‘Why now?’ ‘What is wrong?’ ‘How long will it last?’ ‘How serious is it?’ ‘Who can intervene or treat the condition?’ The clinician can gather a better understanding of the subjective experience of illness, and so promote collaboration and improve clinical outcomes and patient satisfaction. Lloyd et al (1998) and Weiss (1997) have developed instruments to elicit explanatory models. The domains within these are summarised in Table 1, alongside those found in the related Illness Perception Questionnaire, which focuses on physical illness.