Integrating the Illness Meaning and Experience of Patients: the McGill Illness Narrative Interview Schedule as a PCM Clinical Communication Tool

Main Article Content

Danielle Groleau
Nicole Anne D’Souza
Emmanuelle Bélanger


Despite extraordinary progress in biomedical technology and health care services, there is growing criticism of the depersonalization of clinical practice and the limits of medical and professional knowledge. In Person-centered Medicine (PCM), one of the aims is to give systematic attention to the illness meaning and experience of patients and to integrate into medical care the wellbeing, autonomy, spirituality and dignity of patients of diverse cultural backgrounds. There is however a dearth of validated tools clinicians can use to implement a PCM approach during the clinical communication tasks of diagnosis, negotiation of treatment choice and preventive behaviors. In this paper, we will argue that an abbreviated version of the McGill Illness Narrative Interview (MINI) has the potential to be used during clinical communication to implement a PCM approach. This paper will discuss epistemological issues of lay and medical knowledge as well as the patient’s empowerment that need to be addressed in clinical communication. Examples of corresponding clinical communication challenges posed by various medical specialties will be discussed, along with a critical overview of the conceptual models used to guide clinical communication in a PCM manner. Finally we propose that the development and evaluation of a clinical version of the MINI could help address some important challenges to implementing a PCM approach in a clinical context.

Article Details

Regular Articles


Dinh NMH, Groleau D (2008): Traumatic amputation: A case of Laotian indignation and injustice. Culture, Medicine & Psychiatry 32 (3): 440-457.

Mezzich JE, Snaedal J, van Weel C, Botbol M, Salloum I (2010): Introduction to person-centered medicine: from concepts to practice. Journal of Evaluation in Clinical Practice 17(2): 330-332.

Snaedal J (2010): World Medical Association perspectives on person-centered medicine. International Journal of Integrated Care 10 (Suppl): 8-9.

Miles A, Mezzich JE (2011): Advancing the global communication of scholarship and research for personalized healthcare: The International Journal of Person Centered Medicine. International Journal of Person Centered Medicine 1(1): 1-5.

Groleau D, Young A, Kirmayer L (2006): The McGill Illness Narrative Interview (MINI): An interview schedule to elicit meaning and modes of reasoning related to illness experience. Transcultural Psychiatry 43: 671-691.

van Well-Baumgarten E (2010): Person-centered clinical practice. International Journal of Integrated Care 10: 83-85.

Lipkin M, Quill TE, Napodano RJ (1984): The medical interview: A core curriculum for residencies in internal medicine. Annals of Internal Medicine 100(2): 277-284.

Foucault M (1977): Discipline & Punish. Toronto, Random House of Canada.

Elwyn G, Frosch D, Rollnick S (2009): Dual equipoise shared decision making: definitions for decision and behavior support interventions. Implementation Science 4: 75.

Winterbottom A, Bekker HL, Conner M, Mooney A (2008): Does narrative information bias individual's decision making? A systematic review. Social Science & Medicine 67(12): 2079-2088.

Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N (2000): Patients' unvoiced agendas in general practice consultations: Qualitative study. British Medical Journal 320: 1246-1250.

Gravel K, Légaré F, Graham ID (2006): Barriers and facilitators to implementing shared decision-making in clinical practice: A systematic review of health professionals' perceptions. Implementation Science 1: 16.

Légaré F, Ratté S, Gravel K, Graham ID (2008): Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals' perceptions. Patient Education and Counseling 73(3): 526-535.

Belanger E, Rodríguez C, Groleau D (2011): Shared decision-making in palliative care: A systematic mixed studies review using narrative synthesis. Palliative Medicine 25(3): 242-261.

Epstein RM, Korones DN, Quill TE (2010): Withholding information from patients—when less is more. New England Journal of Medicine 362(5): 380-381.

Politi MC, Lewis CL, Frosch DL (2013): Supporting shared decisions when clinical evidence is low. Medical Care Research and Review 70 (1 Suppl): 113S–128S.

Frosch DL, May SG, Rendle KAS, Tietbohl C, Elwyn, G (2012): Authoritarian physicians and patients' fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Affairs 31(5): 1030-1038.

Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR (1995): Patient-Centered Medicine: Transforming the Clinical Method. London, Sage.

Jayadevappa R, Chattre S (2011): Patient centered care: A conceptual model and review of the state of the art. The Open Health Services and Policy Journal 4: 11.

Klinkman M, van Weel C (2011): Prospects for person centered diagnosis in general medicine. Journal of Evaluation in Clinical Practice 17: 6.

Heath I (2010). World Organisation of Family Doctors (Wonca) perspectives on person-centered medicine. International Journal of Integrated Care 10: 10-11.

Greenfield S, Kaplan SH, Ware JE, et al. (1988): Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. Journal of General Internal Medicine 3: 10.

Wagner EH, Bennett SM, Austin BT, Green SM, Schafer JK, Von Korff M (2005): Finding common ground: Patient-centeredness and evidence-based chronic illness care. Journal of Alternative Complementary Medicine 11(1): 9.

World Health Organization. (2003): Adherence to long-term therapies: evidence for action. Available from: Geneva, 2003.

van Dulmen S, van Bijnen E (2011): What makes them (not) talk about proper medication use with their patients? An analysis of the determinants of GP communication using reflective practice. International Journal of Person Centered Medicine 1(1): 27-34.

Groleau D, Lespérance F, Whitley R, Kirmayer LJ (2010): Spiritual reconfiguration of self after a myocardial infarction: influence of culture and place. Health & Place 16: 853-860.

Hoff P (2010): Historical perspectives on person-centered medicine and psychiatry. International Journal of Integrated Care 10: 40-43.

Mezzich JE, Kleinman A, Fabrega H, Parron D (eds) (1996): Culture and Psychiatric Diagnosis. Washington, D.C., American Psychiatric Press

American Psychiatric Association. Task Force on DSM-IV (1994): Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Publishing.

American Psychiatric Association. (2013): Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Kirmayer LJ, Guzder J, Rousseau C. (2014): Cultural Consultation. New York, Springer New York.

Lewis-Fernandez R, Diaz N (2002): The cultural formulation: A method for assessing cultural factors affecting the cultural encounter. Psychiatric Quarterly 73(4): 271-295.

St. Louis ME, Wasserheit JN, Gayle HD (1997): Janus considers the HIV pandemic: Harnessing recent advances to enhance AIDS prevention. American Journal of Public Health 87: 10-12.

Roberts KJ (2002): Physician-patient relationships, patient satisfaction, and antiretroviral medication adherence among HIV-infected adults attending a public health clinic. AIDS, Patient Care and STDs 16(1): 43-50.

Sullivan LM, Stein MD, Savetsky JB, Samet JH (2000): The doctor-patient relationship and HIV infected patients’ satisfaction with primary care physicians. Journal of General Internal Medicine 15: 462-469.

Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB (2004): Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. Journal of General Internal Medicine 19(11): 1096-1103.

Salloum IM, Mezzich JE (2010): Person-centered diagnosis. International Journal of Integrated Care 10: 75-78.

Mead N, Bower P (2000): Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine 51(7): 1087-1110.

Stewart M, Brown JB, Weston WW, Freeman TR (2003): Patient-Centered Medicine: Transforming the Clinical Method (2nd ed.). United Kingdom, Radcliffe Medical Press.

Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB (1986): The patient centered clinical method. 1. A model for the doctor-patient interaction in family medicine. Family Practice 3: 24-30.

Hudon C, Fortin M, Haggerty JL, Lambert M, Poitras M (2011): Measuring patients' perceptions of patient-centered care: A systematic review of tools for family medicine. Annals of Family Medicine 9: 155-163.

Groleau D (2012): Embodying ‘Health Citizenship’ in Knowledge Production to fight health inequalities. Revista Brasileira de Enfermagem, 64(5):,811-816.

D' Andrade RG, Strauss C, eds. (1992): Human Motives and Cultural Models. New York, Cambridge University Press.

Kleinman AM (1980): Patients and healers in the context of culture. Berkeley, University of California Press.

Young A (1981): When rational men fall sick: an inquiry into some assumptions made by medical anthropologists. Culture, Medicine and Psychiatry 5: 317–335.

Groleau D, Soulière M, Kirmayer L J (2006) : Breastfeeding and the cultural configuration of social space among Vietnamese immigrant woman. Health & Place 12(4): 516-526.

Craig SR, Chase L, Lama TN (2010): Taking the MINI to Mustang Nepal: Methodological and epistemological translations of an illness narrative interview tool. Anthropology & Medicine 17(1): 1-26.

Lee BO, Kirmayer LJ, Groleau, D (2010): Therapeutic Processes and Perceived Helpfulness of Dang-Ki (Chinese Shamanism) from the Symbolic Healing Perspective. Culture, Medicine, and Psychiatry 34(1): 56-105.

Dickinson P, Looper KJ, Groleau D (2011): Patients diagnosed with nonepileptic seizures: Their perspective and experience. Epilepsy and Behavior 20: 454-461.

Newton EG, Thombs BD, Groleau D (2012): The experience of emotional distress among women with scleroderma. Qualitative Health Research 22(9): 1195-1206.

Groleau D, Sibeko L (2012): Breastfeeding in the Margins: navigating through the conflicts of social and moral order. In: Beyond Health, Beyond Choice. Breastfeeding Constraints and Realities. Eds. P Hall Smith, BL Hausman, M Labbok. New Jersey, Rutgers University Press.