Patient-centred Medicine  competency based

Detailed knowledge of common diseases - especially their presentations and natural history.

General knowledge of treatable life-threatening or disabling conditions even if rare - especially knowledge of early symptoms and signs.

Understanding of why doctors and patients focus on organic manifestations of sickness and the limitations of this approach.

Practical understanding of the distinction between disease and illness and the clinical relevance of this concept.

Detailed knowledge of the common responses of persons to sickness-their ideas, expectations, feelings, and effects on function.

Working knowledge of illness behaviour and the sick role: why people go to doctors when they do and the benefits and responsibilities of being sick.

Facilitates communication by balancing the use of open-ended and closed-ended techniques.

Avoids behaviour that ‘cuts off’ patients telling their own story of illness--for example, ignoring important cues, interruptions, excessive focus on disease, jargon, premature reassurance, reading the notes, closed posture.

Elicits patients’ experience of illness by facilitating discussion of their ideas, concerns, expectations, and the impact of illness on their lives.

Pays attention to patients’ feelings and responds appropriately to them.

Searches for disease by zeroing in on cues to important disease processes.

Conducts a reliable and efficient evaluation of patients’ functional capacity-physical, emotional, and social.

Recognises early cues to impending disaster.

Develops an efficient approach to the assessment of common presenting signs and symptoms.

Performs a reliable and efficient physical examination of all body systems, in patients of all ages, in a manner that minimises physical and emotional distress.

Avoids one-dimensional views of human sickness: skilfully weaves together the patient’s story of illness with the physician’s biomedical construct of the problem.

Critically analyses data from any source-clinical evaluation, consultants’ opinions, and the medical literature.

Deals with uncertainty and ambiguity appropriately by focusing on the needs and welfare of the patient, rather than on the physician’s desire for precision. Recognizes when it is necessary to make decisions on incomplete or conflicting data.

Willingness to become involved in the full range of difficulties that patients bring to their doctors, and not just their biomedical problems.

Willingness to expend time, intellectual energy, and emotional energy in working with patients.

Deep knowledge of the human condition, especially the nature of suffering and the responses of persons to sickness.

General understanding of the common effects of diseases on persons - physical, emotional, social, and spiritual.

Practical knowledge of the common developmental issues of each stage of human development.

Deep knowledge of the effects of serious illness of one member of a family on the rest of the family. Understands the characteristics and hazards of the carer role. Recognizes the impact of the family in ameliorating, aggravating, or even causing illness in its members.

Knowledge of the cultural beliefs and attitudes of patients that might influence their care.

Applies the biopsychosocial model to define the appropriate contexts for understanding a patient’s problems (e.g., molecules, tissues, organ systems, person, family, community).

Defines patients’ strengths.

Interviews more than one family member at a time to gather information about the patient and about the influence of family interactions and relationships.

Gathers information to construct a family genogram.

Uses home visits to team about the personal and family lives of patients.

Takes an effective employment history to understand the role of work in causing or alleviating patient’s problem.

Addresses patients’ spiritual values and explores, when appropriate, how patients come to terms with their suffering.

Interviews patients within the context of their cultural background. Effectively interacts with patients, using an interpreter.

Respect for the fundamental worth of all persons. Even when patients do not comply with treatment or continue unhealthy lifestyles, the physician will demonstrate belief in their value as persons.

Shows respect for the cultural values of all ethnic groups.

Deep knowledge of the scientific treatment of diseases commonly seen in practice.

Understanding of the local folklore about common conditions seen.

Awareness of the importance of patient autonomy

Understanding of issues that affect patient compliance.

Understanding of how medical decision-making is fundamentally a moral enterprise.

Working knowledge of clinical epidemiology, especially regarding the predictive value of clinical and laboratory information and the critical appraisal of evidence.

Uses expertly the conventional methods of treatment for common problems (e.g., ‘watchful waiting’, modification of lifestyle, medications, minor procedures, hospitalisation, and referral). Also responds appropriately to emergencies and other serious problems, even if rare, for which early treatment makes a difference.

Works with patients to manage effectively the full impact of disease and illness on themselves and their families.

Collaborates with patients to empower them to take an active role in their own care.

Determines patients’ ideas about their problems, their preferences about treatment, and their concepts of the responsibilities of doctor and patient in management.

Communicates information clearly to patients so that they are able to understand their problems and realize what may be done and what they can expect.

Determines how much information regarding their condition patients want or are able to handle.

Addresses differences of opinion with patients so that together they reach a conclusion that is both acceptable and safe for the patient.

Knows when to give in gracefully to patients’ urgent requests or demands and when, in the patients’ best interests, it is essential to confront any differences of opinion.

Willingness to collaborate with patients about management, rather than needing always to ‘take charge.’

Awareness of personal values and cultural differences and how these might interfere with providing unbiased assistance to patients with different values or points of view.

Practical understanding of the importance of continuing comprehensive care and how this differs from episodic care.

General awareness of the characteristics of effective screening tests.

Working knowledge of the evidence for or against the use of commonly recommended screening tests and the value of various preventive strategies (e.g., smoking counselling).

Ability to define a protocol for screening all patients in the practice for those conditions wherein screening has value.

Awareness of models of health promotion and their usefulness.

Collaborates with the patient in developing a practical lifelong plan for health promotion and disease prevention.

At appropriate intervals, monitors patients regarding already recognized problems and screens for unrecognised disease on the basis of an individualized assessment of each patient's risks.

Uses the medical record system effectively - as a reminder and also to document screening and prevention (e.g., problem lists, flow sheets, tickler files, computer systems).

Collaborates with the team to implement a programme of screening and prevention in the practice.

Enhances the patients 'self-esteem and self-confidence in caring for themselves.

Has enthusiastic interest in all three stages of prevention - primary, secondary, and tertiary

Invests time and energy to incorporate screening, prevention, and health promotion into day-to-day care of patients.

Acknowledges the importance of health promotion activities.

Self-awareness of personal strengths and weaknesses in working with patients.

Awareness of emotional reactions to patients.

Understanding of the basic factors underlying an effective patient-doctor relationship: unconditional positive regard, empathy, and genuineness.

Understanding of the healing power and spiritual aspects of the patient-doctor relationship.

Working knowledge of the placebo effect.

Working knowledge of transference and counter-transference.

Communicates effectively both verbally and nonverbally to connect with patients in meaningful and helpful ways.

Creates a sense of security and comfort, both by his or her interactions with patients and by his or her very presence.

Uses personal qualities effectively - empathy, generating trust and confidence, providing support and encouragement, being a model, and providing inspiration.

Uses physical contact with patients to allay fears, to establish therapeutic bonds, and to provide comfort.

Is able to 'be with' patients in a healing relationship: attends fully to patients and their needs without always having to interpret or intervene.

Uses repeated contacts to build up personal knowledge of patients and their families. Helps patients deal with termination of the doctor-patient relationship by preparing them in advance and by providing opportunities to discuss their feelings about the relationship and about their loss.

Recognizes which patients require special approaches to interviewing and treatment (e.g., recognizes patients who have unquenchable needs for support and, kindly but firmly, sets appropriate limits on the amount of time and energy he or she is able to expend).

Willingness to step into open-ended relationships with patients in which the demands are often unknown in advance.

Risks exposing areas of weakness and vulnerability.

Risks being hurt.

Has willingness to make personal sacrifices when necessary for the well-being of patients.

Exhibits long-term commitment to the well-being of patients. The relationship is a form of covenant: Physicians promise to be faithful to their commitments even if patients do not comply or follow through on theirs.

Willingness to 'go to bat' for patients to protect them from the hazards of the health care system.  

Awareness of community resources.

Understanding of the severe limitations of medicine to alter the natural course of disease.

Understanding of the task of medicine: “To cure sometimes, to relieve often, to comfort always”.

Organizes time effectively and efficiently and, as much as possible, keeps to time. Recognizes when a patient's situation requires extra time even if this disrupts the schedule.

Zeroes in on the heart of the problem: Does not ‘lose the forest for the trees’.

Focuses on patients' prime needs but does not allow patients to ramble. Helps them identify their central concerns.

Uses follow-up effectively; does not try to do everything for every patient on each visit.

Works effectively as a member of a health care team, contributing his or her expertise and delegating appropriately.

Sets reasonable goals and priorities.

Exhibits wise stewardship of limited community resources: balances needs of individual patients with the needs of the community.

Avoids being overextended by limiting responsibilities to what realistically can he accomplished.

Has self-awareness of limitations and personal responses to stress.

Accepts that physicians cannot be all things to all people. Able to say no without guilt

Expends time and energy building personal relationships within his or her family.

Willingness to ask for help when needed.