The patient's concern- "the second diagnosis"

Abstract

It is argued that "the patient's concern" needs to take precedence over the doctor's agenda in the clinical interview, especially at the primary health care level where the approach in health care delivery is more person-oriented than dis ease-orientated. Yudkin's notion of "the second diagnosis" is explored and developed. The doctor's knowledge about the patient's cultural background, and his language is essential for effective communication between the doctor and his patient. Some of the skills necessary to deal with "the patient's concern" q,re described and, a, demonstration of their application during the interview of four patients is presented in the form of transcripts. It is suggested that such skills can be taught to medical students and, reinforced at the post-graduate level, particularly during the envisaged period of medical vocational training in South Africa.