Eliciting the Patient’s Perspective

The care provider can try to elicit the patient’s illness narrative (sometimes called explanatory model of illness) by asking some of the following questions to gain a better understanding of the patient’s point of view.

1. What do you call the problem? (e.g. Epilepsy is believed to be Mirgi, caused by evil spirits and instead of seeking medical help, religious specialists called pirs are sought out to exorcise these jinns.)

2. Why do you think this illness or problem has occurred? (e.g., patient may feel that the problem is a punishment given by God for bad deeds committed or due to failure to pray.)

3. What do you think the illness does? e.g., patient may feel that the illness is washing away her/his sins and would resolve once the sins are washed away or by doing certain religious rituals.)

4. What do you think is the natural course of the illness? What do you fear? (e.g. patients may either have undue fear of the disease or on the other hand may trivialize the disease and feel that it can be resolved by prayer.) It is important to understand the patient’s bias so that appropriate education can be provided.

5. How do you think the sickness should be treated? (What alternative therapies are you using currently?) How do want us to help you? These questions should be addressed sensitively so as not to convey an impression of clinical incompetence to the patient and family. Once the patients’ expectations are known, then therapy could be modified to suit their needs, if possible.

6. Who do you turn to for help? Who should be involved in decision-making? Pakistanis have a close knit family structure and the family unit often makes important decisions.

Once the care provider is better able to understand the patient, a trusting relationship can be established, thus leading to better outcomes for both patient and provider.