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September 8, 1993

'Windows of Opportunity' to Address Patients' Concerns: Too Small and Too Few?

Author Affiliations

Corrales. NM

JAMA. 1993;270(10):1195-1196. doi:10.1001/jama.1993.03510100045017

To the Editor.  —Drs Branch and Malik1 offer guidance to physicians "who wish to meet their patients' psychological and social as well as medical needs." They discovered in 20 videotaped medical encounters conducted by five experienced internists a total of four occasions when the patient's concerns received more than "acknowledgment with little exploration."Should we be surprised that 16 of the 20 videotaped interviews did not achieve these modest success criteria because (among other reasons offered) a physician may have a "lack of confidence that he or she could deal with a patient's concern and easily make the transition back to medical history taking"? It seems a likely consequence of the biomedical model that has informed both the investigation and the videotaped clinical practice: a model with its notion of "the body as a machine, of disease as a consequence of breakdown of the machine, and the doctor's task