In search of excellence. Expanding the patient-centred clinical method: a three-stage assessment.

Excellence in caring for the patient has been pursued in better technology and better management structures with multidisciplinary teams. Excellence is increasingly sought through taking the whole person seriously and in developing better ways of working with relationships. This paper traces the growth of ideas and their application in a university department of family medicine, toward a holistic and more patient-centred, three-stage clinical method. This three-stage assessment helps the patient and the physician to deal holistically with the problem. The biological, the psychological and the environmental systems as well as their interrelationships are considered as they impact on health and illness. This method of arriving at a 'best-fit' understanding of a person's problem, by the doctor and the patient together, helps to individualize the assessment and management. Excellence is more likely to be found when we care in an individualized way within a systems understanding.