The Circle of Change

The clinician-patient relationship is an unapologetic reminder that clinical practice is an applied science, and that clinical knowledge only becomes useful through human interaction and application. Through dialog, the relationship serves as a powerful conduit for information flow. This text, utilizing stories of successes and failures I have journaled over 44-years practicing medicine, argues that there is hidden knowledge important to patient care beyond technology's reach that can only be gained through mutual trust, rapport and the right questions asked. But there are many external factors that constrain and strain the clinician-patient relationship. Institutional and cultural restrictions foisted upon medical practice are laden with bureaucratic, political, and economic demands which impinge upon time spent with the patient. Correcting the situation is challenging because many of the causative factors are of a societal nature and not within one individual's influence. But nurturing the clinician-patient relationship and harvesting information from patients' stories that may explain conflict, impasse, resistance to plan of care and lifestyle changes is well within our scope and is in fact necessary for good care. As such, it is the clinician's job to develop skills for impasse resolution and interview techniques to explore the personal, family and cultural relational dynamics and nuances of meaning, lying within the illness narrative. While physicians, physician assistants, nurse practitioners, and others are well-trained to take inventory of the body's biological systems, practitioners often lack the skill set to ask "the right questions" for exploring psychosocial systems, and therein lies the pedagogic vacuum to be filled. It is the purpose of this text to introduce a meaning-based problem-solving approach, The Circle of Change, as a pragmatic map and compass for gathering and processing patients' narratives to uncover meaning and care for