The Medical Interview: The Three-Function Approach

introductory biostatistics book of the fourth type as defined above. Given the author's ability to describe statistical concepts, I am just a bit disappointed that he did not include some of the more clinical dimensions as well. Nevertheless, those who want a thorough but eminently readable introduction to biostatistics are strongly advised to obtain this book. Communication is a fundamental requirement of human social interaction. In many cases, it is the crucial link to subsequent effective action. Law and education are examples of professions dependent on effective multilateral communication for success. It has been less clear that the same interdependence on communication exists in medicine. Historically, medicine has taught the absolute importance of gathering data to diagnose disease and identify treatment. Professional skill was developed through identification and clarification of information presented by the patient. Much less emphasis was placed on communicating the consequences of the subsequent diagnosis to the patient and his or her family. This approach ignored the realities of disease and health. Patients bear the burden of prognosis and treatment and retain the ultimate responsibility for compliance. Evidence has shown that the manner in which the physician communicates with the patient affects emotional adjustment to illness and compliance with therapy. It may even affect the outcome of the illness itself. The profession of medicine therefore illustrates a special circumstance in which poor communication of information by the physician may alter patient compliance, the subsequent progression of illness, the degree of associated suffering, or the likelihood of death. The three-function model of the medical interview developed by the author specifically addresses these issues. It identifies three components of the interview which are of critical importance to a successful outcome of the doctor-patient interaction. The first function involves the gathering of data to understand the patient's problems. This function has been universally recognized by doctors and medical students as the primary purpose of the medical interview. The second function involves the development of doctor-patient rapport and the appropriate physician response to a patient's emotions. In the past, medicine has relied on the intuitive ability of physicians and medical students regarding this issue. There is substantial evidence, however, that this intuitive ability is not sufficient. This second function involves several basic relationship skills that may be mastered by medical students and practicing physicians. The single most important quality identified by the author is the ability to communicate empathic appreciation of …