Clinical Case   You admit Mary, a new patient, to the hospital.  Mary has end-stage, metastatic pancreatic cancer.  She has not seen a physician since she was given a terminal diagnosis 6 months ago at another institution.  She is nutritionally depleted and has an apparent gastrointestinal obstruction causing significant bloating and discomfort.  While you are admitting her she informs you that she is curing herself by drinking fresh fruit and vegetable juices.  She refuses to discuss advanced directives because she “Does not trust you.” 

Patient-centered Interviewing   How might you begin to develop a working relationship with Mary?  One strategy is to strive to understand both Mary’s disease and her illness.  Disease refers to a biological, pathophysiological process.  Illness refers to the patient’s experience.  You can assess a patient’s illness experience by asking about 4 dimensions—Feelings, Ideas, Function and Expectations.  The acronym FIFE can be a helpful reminder.

F = FEELINGS related to the illness, especially fears

• What are you most concerned about?
• Do you have any specific fears or worries right now?
• I imagine you have had many different feelings as you have coped with this illness.
• Sometimes people have fears that they keep to themselves and don’t tell their doctor.

I = IDEAS and explanations of the cause of a symptom or illness

• What do you think might be going on?
• What do you think this pain means?
• Do you have ideas about what might have caused this illness?

F = FUNCTIONING – the illness’ impact on daily life

• How has your illness affected you day to day?
• What have you had to give up because of your illness?
• What goals do you have now in your life?  How has your illness affected your goals?
• How does this illness affect important people in your life? 

E = EXPECTATIONS of the doctor & the illness

• What do you expect or hope I can do for you today?
• Do you have expectations about how doctors can help?
• What do you hope this treatment will do for you?
• What are your expectations about what might happen with this illness?

References

1. StewartM, Brown JB, et al.  Patient Centered Medicine: Transforming the Clinical Method. Sage Publications, Thousand Oaks, California; 1995.
2. Rosenberg EE, et al.  Lessons for clinicians from physician-patient communication literature.  Arch Fam Med. 1997; 6:279-283
3. Platt FW, Gaspar DL. “Tell me about yourself”: The patient-centered interview. Ann Int Med. 2001; 134:1079-1085.

Version History: This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published August 2005; 3rd Edition May 2015. Current version re-copy-edited May 2015.