Arthur Kleinman’s explanatory model of illness helps you provide patient-centered care, and can be applied in diferent contexts – not just health.
This set of 8 questions helps you understand:
- the client’s beliefs about their illness or situation
- the personal and social meaning they attach to their condition
- their expectations about what will happen to them and what you, the provider, will do
- their own therapeutic goals.
The concept of the explanatory model was first proposed by Arthur Kleinman, who developed a set of questions to ask a client to learn more about their illness and views. These questions are below. Ask them in order.
Eight questions to ask your clients:
1. What do you think caused your problem?
This question gets at the patient’s beliefs about the cause of illness, probably the most fundamental and important aspect
of the explanatory model.
2. What do you call the illness/problem?
This question is especially helpful when you suspect the patient believes a particular folk illness to be causing the symptoms.
3. Why do you think it started when it did?
This can link the illness to certain events in the patient’s life that may be important elements of the explanatory model.
4. What do you know about the illness and how it works?
Many patients may not be able to describe how the illness works at this level, but will have some understanding of
what it means to them.
5. How severe is the problem? How worried are you about it?
Patients may be very worried about an illness while the physician is not. For example, when there are symptoms that
do not suggest any concerning diseasebut are very upsetting to the patient. This is important to discuss as openly as possible.
6. What kind of treatment/help do you think you should receive, and what are the most important results you hope to get from this treatment?
Part of the patient’s understanding of the illness has to do with beliefs about its treatment. The patient’s opinions on
traditional, western and alternative therapies should be taken into consideration.
7. What are the main problems the illness has caused?
Understanding this allows better insight into the patient’s unique illness experience.
8. What do you fear most about the illness?
This is a crucial question because it allows the physician to tailor the explanation of the illness and its treatment
to the patient’s concerns.
Source: Kleinman, A. 1988, The Illness Narratives: Suffering, Healing and the Human
Condition, Basic Books, New York