This time, in addition to talking about the wrist, the NP asks the boy about school. In their interview, he tells her that he doesn't mind that he can't hold a pencil because he is not a very good student. The problem is now framed as a school-related issue, and the treatment plan can include a school guidance counselor. While neither encounter can necessarily be called right or wrong, the communication choices lead to different outcomes. An important technique in the medical interview, according to Putnam, is to be aware of different branch points - points at which the conversation can go in different directions, any one of which may affect the outcome.
Many medical complaints relate to the stresses and strains of living.
In this model, the patient's thoughts, feelings, and experiences are integrated into the biologic process. The medical relationship goes beyond just the clinician-patient, and includes the patient's family and community. The model acknowledges that the clinician is not merely a detached observer, but brings his or her biases and experiences to the medical interview. The interactive process is so engaging - you can never grow tired of it. He adds that the clinician who makes the effort can always get better at the process.