A P PE N D IX 2
Kleinman’s Explanatory Model of Illness
Kleinman and associates (1978) in their seminal paper further discuss cuss the the impo import rtan ance ce of the the expl explan anat ator ory y mode model: l: “Eli “Elici citi ting ng the the pati patien ent’ t’ss (expl (explan anat ator ory) y) mode modell give givess the the phys physic icia ian n know knowle ledge dge of the the belie beliefs fs the the patient holds about his illness, the personal and social meaning he attaches attaches to his disorder, disorder, his expectations expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Comparison of patient model with the doctor’s model enables the clin clinic icia ian n to iden identi tify fy majo majorr disc discre repa panci ncies es that that may may caus cause e prob proble lems ms for for clin clinic ical al mana managem gemen ent. t. Such Such comp compar aris ison onss also also help help the the clin clinic icia ian n know know which aspects of his explanatory model need clearer exposition to patients (and families), and what sort of patient education is most appropriate. And they clarify conflicts not related to different levels of knowledge but different values and interests. Part of the clinical process involves negotiations between these explanatory models, once they have been made explicit.” Eliciting the Patient’s Explanatory Model of illness through a set of targeted questions shown below is an important tool for facilitating cross-cultural communication, ensuring patient understanding, and identifying areas of conflict that will need to be negotiated. The wording and number of questions used will vary depending on the characteri characteristics stics of the patient, the problem, problem, and the setting. What do you think has caused your problem? Why do you think it started when it did? What do you think think your sickness sickness does to you? How does it work? How severe is your sickness? Will it have a short or long course? What kind of treatment do you think you should receive? r
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Achieving Cultural Competency: Compet ency: A Case-Based Approach to Training Tr aining Health Professionals Profes sionals
Edited by L. Hark, Hark, H. DeLisser © 2009 Blackwell Blackwell Publishing Publishing Ltd. ISBN: 978-1-405-18072 978-1-405-18072-6 -6
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Appendix 2
What are the most important results you hope to receive from this treatment? What are the chief problems your sickness has caused for you? What do you fear most about your sickness?
Adapted from, Kleinman A., Eisenberg L., Good B. Culture, illness, and care: clinical lessons from anthropological and cross-cultural research. Ann Intern Med 1978;88:251–88.
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Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals Duration: Maximum of 25 hours, each case should take 1 hour Credit: Up to 25 AMA PRA Category 1 Credits TM , each case is awarded 1 AMA PRA Category 1 Credit TM Original Release Date: June 1, 2009 Last Review Date: January 5, 2009 Expiration: May 31, 2012 Completion Instructions To receive CME credit for each case that you complete from this book, please visit the University of Pennsylvania Office of Continuing Medical Education website at: http://www.med.upenn.edu/ cme/culture/ Once on the site, you will be presented with the option to choose from two topics. The topic for this book is called “Achieving Cultural Competency Book Cases (Wiley-Blackwell 2009)”. After choosing this topic, you will be presented with a complete list of cases from this book. Select the case(s) for which you would like to receive CME credit. In order to access any of these cases, you must have an account on the CME Website (complementary). If you do not have an account, sign-up (click on member sign-up at the top of the page). If you have an account, log into the site with your e-mail address and password (click on log-in at the top of the page). Next, register for a particular activity (case) by using the link in the “Course Materials” box on the right. When prompted for an access code, enter: culturebook (Note: the access code is case-sensitive). Click on the “Get CME” link in the “Course Materials” box. You now need to complete the Post-Test. After successfully completing the Post-Test, with a score of 75% or higher, you will be directed to the Evaluation. After completing the Evaluation, you will be able to view, print, or save a CME certificate verifying your credit for this activity. r
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