Vol. 49 No. 6 June 2015
Journal of Pain and Symptom Management 973
Promoting Evidence in Practice Series Editor: Sydney M. Dy, MD, MS
Acknowledging the Person in the Clinical Encounter: Whole Person Care for Patients and Clinicians Alike. Commentary on Chochinov et al. Christina M. Puchalski, MD, MS, FACP, FAAHPM, and Najmeh Jafari, MD George Washington Institute for Spirituality and Health, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Chochinov et al.,1 inspired by the work of Charon2 and building on the Dignity Model,3 describe an innovative clinical question called the Patient Dignity Question (PDQ) as a way of eliciting an understanding of personhood. The study underscores the importance of a humanistic and compassionate approach to patients and families to improve clinical care and the patient experience as well as enhance clinicians’ sense of meaning in their professions. Lay and professional literature demonstrate a common themedpeople do not want to be treated as a ‘‘disease.’’ They want to be treated holistically, with their own story at the center of the clinical encounter. Various movements, such as dignitycentered medicine, spirituality and health, and palliative care, have been advocating for more whole-person models of care. The PDQ is a good tool to enhance person-centered care. Challenges include limited time in the clinical setting and the need to blend the humanistic and scientific in one encounter. One question is unlikely to elicit all physical and psychosocial/spiritual issues for
all patients. Clinicians with extensive experience were responsive to the PDQ data, indicating that experience may lead to better navigation of the art and science of medicinedknowing what other questions to ask in the conversation. Training is needed so that clinicians can identify psychosocial and spiritual issues; training should be focused on the clinician’s inner formation so that the question will be asked authentically, not as a checklist.
Address correspondence to: Christina M. Puchalski, MD, MS, FACP, FAAHPM, George Washington Institute for Spirituality and Health, The George Washington University School of Medicine and Health Sciences, 2030 M. Street, NW, Suite
4014, Washington, DC 20036, USA. E-mail: cpuchals@ gwu.edu Accepted for publication: April 29, 2015.
Ó 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
References 1. Chochinov HM, McClement S, Hack T, et al. Eliciting personhood within clinical practice: effects on patients, families and health care providers. J Pain Symptom Manage 2015;49:974e980. 2. Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001;286:1897e1902. 3. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ 2007;335: 184e187.
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2015.04.008
Journal of Pain and Symptom Management 973
Promoting Evidence in Practice Series Editor: Sydney M. Dy, MD, MS
Acknowledging the Person in the Clinical Encounter: Whole Person Care for Patients and Clinicians Alike. Commentary on Chochinov et al. Christina M. Puchalski, MD, MS, FACP, FAAHPM, and Najmeh Jafari, MD George Washington Institute for Spirituality and Health, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Chochinov et al.,1 inspired by the work of Charon2 and building on the Dignity Model,3 describe an innovative clinical question called the Patient Dignity Question (PDQ) as a way of eliciting an understanding of personhood. The study underscores the importance of a humanistic and compassionate approach to patients and families to improve clinical care and the patient experience as well as enhance clinicians’ sense of meaning in their professions. Lay and professional literature demonstrate a common themedpeople do not want to be treated as a ‘‘disease.’’ They want to be treated holistically, with their own story at the center of the clinical encounter. Various movements, such as dignitycentered medicine, spirituality and health, and palliative care, have been advocating for more whole-person models of care. The PDQ is a good tool to enhance person-centered care. Challenges include limited time in the clinical setting and the need to blend the humanistic and scientific in one encounter. One question is unlikely to elicit all physical and psychosocial/spiritual issues for
all patients. Clinicians with extensive experience were responsive to the PDQ data, indicating that experience may lead to better navigation of the art and science of medicinedknowing what other questions to ask in the conversation. Training is needed so that clinicians can identify psychosocial and spiritual issues; training should be focused on the clinician’s inner formation so that the question will be asked authentically, not as a checklist.
Address correspondence to: Christina M. Puchalski, MD, MS, FACP, FAAHPM, George Washington Institute for Spirituality and Health, The George Washington University School of Medicine and Health Sciences, 2030 M. Street, NW, Suite
4014, Washington, DC 20036, USA. E-mail: cpuchals@ gwu.edu Accepted for publication: April 29, 2015.
Ó 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
References 1. Chochinov HM, McClement S, Hack T, et al. Eliciting personhood within clinical practice: effects on patients, families and health care providers. J Pain Symptom Manage 2015;49:974e980. 2. Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001;286:1897e1902. 3. Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ 2007;335: 184e187.
0885-3924/$ - see front matter http://dx.doi.org/10.1016/j.jpainsymman.2015.04.008
