Psychiatric Interview

However, the psychiatric interview primarily assesses for “productive” syndromes,

such as delusions, hallucinations, and depression, rather than cognitive deficits from
a normal baseline.

From: The Mental Status Examination Handbook, 2022

Related terms:

Confinement, Automutilation, Posttraumatic Stress Disorder, Depression, Mental

Health

View all Topics

Introduction
Mario Mendez, in The Mental Status Examination Handbook, 2022

Psychiatry and Neuropsychology

The psychiatric interview and neuropsychological testing are related techniques for
the assessment of mental status abnormalities, and their similarities and differences
with the cognitively oriented MSX in this handbook needs clarification (Table 1.1).
Similar to the MSX, psychiatric interviews and neuropsychological testing elicit
behavioral information from patients that can be related to brain structure and
function. However, the psychiatric interview primarily assesses for “productive”
syndromes, such as delusions, hallucinations, and depression, rather than cognitive
deficits from a normal baseline. The psychiatric interview tends to be descriptive,
historical, and qualitative, but it should never be underestimated for it too is an
extremely valuable tool that requires much skill. In addition, the psychiatric exami-
nation includes quantitative assessments in the form of brief, corroborative scales or
inventories, and most psychiatrists usually include cognitive mental status testing
in their examinations.

Compared to mental status tests, neuropsychological tests are standardized instru-

ments with strong psychometric properties such as validity and reliability, and they
have normative values. These tests are usually administered as neuropsychologi-
cal batteries that are comprehensive, although requiring hours to administer and
score. Neuropsychological assessment is a powerful gold standard for determining
cognitive abilities, and generally serves as the standard for many mental status
tests. Neuropsychology stresses the determination of intellectual strengths and
weaknesses, individual differences, and the potential for rehabilitation, whereas the
MSX emphasizes the diagnostic value of “signature” clinical syndromes, such as
aphasias, amnesias, or agnosias. Compared to mental status testing, neuropsy-
chological testing requires a controlled setting with extended testing time, special
stimulus materials, delayed scoring, and lacks flexibility of administration (e.g., in
test setting, test time, and variation in test application). These limit the extensive
use of neuropsychological testing in the clinic or the bedside, although they remain
extremely useful for specific indications. Ultimately, MSX and neuropsychological
assessment are highly complementary approaches in the evaluation of patients
with brain-behavior disorders. Moreover, mental status testing benefits greatly from
informal validation of findings by a comparable neuropsychological test.

> Read full chapter

Medical Discourse: Psychiatric Inter-

views
B.T. Ribeiro, D. de Souza Pinto, in Encyclopedia of Language & Linguistics (Second
Edition), 2006

The psychiatric interview is a key diagnostic instrument for psychiatrists given that
laboratory exams do not provide evidence for psychopathologic processes. Psychiatry
derives its practice from clinical observations that take place in face-to-face en-
counters between patient and doctor where thought, language, and communication
disorders are closely investigated. Understanding, and describing, such disorders
assigns a prominent role to language studies, where linguists can contribute to
more adequate descriptions for language and cognitive disorders. Research on topic,
frame, and narrative analysis provides interesting frameworks for the development
of studies in the social construction of identity and discourse coherence in psychia-
try.

> Read full chapter

The Psychiatric Interview

Eugene V. Beresin M.A., M.D., ... Christopher Gordon M.D., in Massachusetts
General Hospital Handbook of General Hospital Psychiatry (Sixth Edition), 2010

BUILDING THE RELATIONSHIP AND THERAPEUTIC AL-

LIANCE
All psychiatric interviews must begin with a personal introduction and establish the
purpose of the interview; this helps create an alliance around the initial examination.
The interviewer should attempt to greet the person warmly and use words that
demonstrate care, attention, and concern. Note-taking and use of computers should
be minimized and, if used, should not interfere with ongoing eye contact. The
interviewer should indicate that this interaction is collaborative, and that any misun-
derstandings on the part of patient or physician should be immediately clarified. In
addition, the patient should be instructed to ask questions, interrupt, and provide
corrections or additions at any time. The time frame for the interview should be
announced. In general, the interviewer should acknowledge that some of the issues
and questions raised will be highly personal, and that if there are issues that the
patient has real trouble with, he or she should let the examiner know. Confidentiality
should be assured at the outset of the interview. If the psychiatrist is meeting a
hospitalized patient at the request of the primary medical or surgical team, this
should be stated at the outset.

These initial guidelines set the tone, quality, and style of the clinical interview. An
example of a beginning is, “Hi, Mr. Smith. My name is Dr. Beresin. It is nice to meet
you. Your surgeon, Dr. Jones, asked me to meet with you because he is concerned
that you haven't eaten or taken any of your medications since you've been in the
hospital. I would like to discuss some of the issues or problems you are dealing with
so that we can both understand them better, and figure out what kind of assistance
may be available. I will need to ask you a number of questions about your life, both
your past and present, and if I need some clarification about your descriptions I will
ask for your help to be sure I ‘get it.’ If you think I have missed the boat, please chime
in and correct my misunderstanding. Some of the topics may be highly personal,
and I hope that you will let me know if things get a bit too much. We will have about
an hour to go through this, and then we'll try to come up with a reasonable plan
together. I do want you to know that everything we say is confidential. Do you have
any questions about our job today?” This should be followed with an open-ended
question about the reasons for the interview.

One of the most important aspects of building a therapeutic alliance is helping the
patient feel safe. Demonstrating warmth and respect is essential. In addition, the
psychiatrist should display genuine interest and curiosity in working with a new
patient. Preconceived notions about the patient should be eschewed. If there are
questions about the patient's cultural background or spiritual beliefs that may have
an impact on the information provided, on the emotional response to symptoms, or
on the acceptance of a treatment plan, the physician should note at the outset that if
any of these areas are of central importance to the patient, he or she should feel free
to speak about such beliefs or values. The patient should have the sense that both
doctor and patient are exploring the history, life experience, and current symptoms
together.

For many patients, the psychiatric interview is probably one of the most confusing
examinations in medicine. The psychiatric interview is at once professional and
profoundly intimate. We are asking patients to reveal parts of their life they may
only have shared with extremely close friends, a spouse, clergy, or family, if anyone.
And they are coming into a setting in which they are supposed to do this with a
total stranger. Being a doctor may not be sufficient to allay the apprehension that
surrounds this situation; being a trustworthy, caring human being may help a great
deal. It is vital to make the interview highly personal and to use techniques that
come naturally. Beyond affirming and validating the patient's story with extreme
sensitivity, some clinicians may use humor and judicious self-revelation. These
elements are characteristics of healers.22

An example should serve to demonstrate some of these principles. A 65-year-old

deeply religious woman was seen to evaluate delirium following cardiac bypass
surgery. She told the psychiatric examiner in her opening discussion that she wanted
to switch from her primary care physician, whom she had seen for more than 30
years. As part of her postoperative delirium, she developed the delusion that he
may have raped her during one of his visits with her. She felt that she could not
possibly face him, her priest, or her family, and she was stricken with deep despair.
Although the examiner may have recognized this as a biological consequence of her
surgery and postoperative course, the patient's personal experience spoke differently.
She would not immediately accept an early interpretation or explanation that her
brain was not functioning correctly. In such a situation, the examiner must verbally
acknowledge her perspective, seeing the problem through her eyes, and helping
her see that he or she “gets it.” For the patient, this was a horrible nightmare. The
interviewer might have said, “Mrs. Jones, I understand how awful you must feel. Can
you tell me how this could have happened, given your long-standing and trusting
relationship with your doctor?” She answered that she did not know, but that she was
really confused and upset. When the examiner established a trusting relationship,
completed the examination, determined delirium was present, and explained the
nature of this problem, they agreed on using haloperidol to improve sleep and
“nerves.” Additional clarifications could be made in a subsequent session after the
delirium cleared.
As noted earlier, reliable mirroring of the patient's cognitive and emotional state
and self-reflection of one's affective response to patients are part and parcel of
establishing secure attachments. Actively practicing self-reflection and clarifying
one's understanding helps to model behavior for the patient, as the doctor and
patient co-create the narrative. Giving frequent summaries to “check in” on what the
physician has heard may be very valuable, particularly early on in the interview, when
the opening discussion or chief complaints are elicited. For example, consultation
was requested after a 22-year-old woman who was hospitalized for emergency
surgery refused to go to a rehabilitation facility. During the course of the psychiatric
interview, the physician elicited a history of obsessive–compulsive symptoms during
the past 2 years that led her to be housebound. The interviewer said, “So, Ms.
Thompson, let's see if I get it. You have been stuck at home and cannot get out of
the house because you have to walk up and down the stairs for a number of hours.
If you did not ‘get it right,’ something terrible would happen to one of your family
members. You also noted that you were found walking the stairs in public places,
and that even your friends could not understood this behavior, and they made fun
of you. You mentioned that you had to ‘check’ on the stove and other appliances
being turned off, and could not leave your car, because you were afraid it would
not turn off, or that the brake was not fully on, and again, something terrible would
happen to someone. And you said to me that you were really upset because you knew
this behavior was ‘crazy.’ How awful this must be for you! Did I get it right?” The
examiner should be sure to see both verbally and nonverbally that this captured the
patient's problem. If positive feedback did not occur, the examiner should attempt to
see if there was a misinterpretation, or if the interviewer came across as judgmental
or critical. One could “normalize” the situation and reassure the patient to further
solidify the alliance by saying, “Ms. Thompson, your tendency to stay home, stuck,
in the effort to avoid hurting anyone is totally natural given your perception and
concern for others close to you. I do agree, it does not make sense, and appreciate
that it feels bizarre and unusual. I can see why it would be upsetting to have to wait
any longer to return home. I think we can better understand this behavior, and later
I can suggest ways of coping and maybe even overcoming this situation through
treatments that have been quite successful with others. However, I do need to get
some additional information. Is that OK?” In this way, the clinician helps the patient
feel understood—that anyone in that situation would feel the same way, and that
there is hope. But more information is needed. This strategy demonstrates respect
and understanding and provides support and comfort, while building the alliance.

> Read full chapter

Psychiatric Consultation to Medical
and Surgical Patients
Nicholas Kontos MD, John Querques MD, in Massachusetts General Hospital Com-
prehensive Clinical Psychiatry, 2008

Interview the Patient

The psychiatric interview of a patient in the general hospital is identical in prin-
ciple to that performed in most other venues. Areas of inquiry are identified; a
diagnosis is pursued; and contributing factors from other aspects of the patient's
background, current circumstances, and personal characteristics are elicited. A
longitudinal conceptualization of the problem is useful (Figure 54-1). Thorough
description of the presenting problem should be followed by an appraisal of the
patient's psychological baseline. The patient should be asked when she last felt like
her “usual self ” rather than when she last felt “normal” or “good,” since some
patients do not view themselves in these terms. Descriptions of that time should
be provided and detailed questions should be asked (e.g., “How did you spend your
time then?” and “Would I notice a difference about you if I met you then?”). The
patient should be invited to speculate on how her “usual self ” might cope differently
with her medical situation. If the answer is “the same,” this provides an opportunity
to explore characterological vulnerabilities. If not, this becomes an opportunity to
look at intervening psychopathology or at demoralization. Either way, most patients
appreciate the psychiatrist's interest in matters other than their symptoms. After this
baseline is obtained, triggers or harbinger symptoms of the presenting problem
can be identified. Last, since most psychopathology is episodic, a history of similar
problems in the past can be elicited. Many patients cannot be interviewed in such a
fashion, but the history can still be organized this way after the interview.

A schema for understanding the scope of the consulting psychiatrist's interview

is presented in Figure 54-2. Although the consultee's question must be kept in
mind throughout the interview, consultees often misidentify psychopathology and
thus the consultation question should be taken only as a suggestion.3–5 At the same
time, the psychiatrist should not function as the local “biopsychosocial expert,” for
whom just about anything in the patient's life is worthy of attention.6 Rather, the
consultant should generally situate himself or herself just outside the border of the
“missed by consultee” circle and just inside the “important–but not acutely” circle.
Keeping the interview in this area requires clinical judgment beyond simply “being
biopsychosocial.” For example, a patient with acute apathy after a stroke has very
different needs from the patient with a life-long obsessive-compulsive personality
disorder who is driving his family and the hospital staff to distraction after a hip
replacement (Figure 54-3).
> Read full chapter

Measures of Alexithymia
Bob Bermond, ... Harrie C.M. Vorst, in Measures of Personality and Social Psycho-
logical Constructs, 2015

Based on 20 psychiatric interviews with psychosomatic disordered patients, Nemiah

and Sifneos (1970a) observed that they:

‘manifested either a total unawareness of feelings or an almost complete incapacity

to put into words what they were experiencing. The associations of the majority of
the patients were characterized by a nearly total absence of fantasy or other material
related to their inner, private mental life of thoughts, attitudes and feelings, and a
recounting, often in almost infinite detail, of circumstances and events in their envi-
ronment, including their own actions. Their thoughts, that is, were stimulus-bound
rather than drive-directed.’

> Read full chapter

COGNITIVE DYSFUNCTION AND

OTHER COMORBIDITIES | Behav-
ioral and Cognitive Comorbidities
R. Caplan, in Encyclopedia of Basic Epilepsy Research, 2009

Range and Type of Behavior Problems in Children with Epilepsy

Using a structured psychiatric interview administered separately to the child and
parents, we found high rates of psychiatric diagnoses in children with CPS and
children with CAE, children with epilepsy recruited from community and from
epilepsy centers compared to normal children (Table 1). In both CPAS and CAE the
most frequent diagnosis was ADHD followed by anxiety/mood disorders and then
both ADHD and anxiety/depression. Among the children with anxiety/depression,
62% had anxiety disorders, 24% depression, and 14% both anxiety disorder and
depression diagnoses. We also found high rates of suicidal ideation in 20% and
suicidal plans in 37% of our sample, particularly in children with both ADHD and
anxiety/depression diagnoses.

Table 1. Psychiatric Diagnoses in CPS, CAE, and Normal Children

 CPS CAE Normal
N 103 80 101
Psychiatric Diagnosis 56% 57% 15%
ADD* 17% 23% 6%

Affective/Anxiety 14% 18% 7%

ADD + Affective/Anxiety 23% 12% 2%
Other 2% 4% 0%
No diagnosis 56% 43% 85%
CBCL T  60
Total 40% 35% 12%
Internalizing 42% 35% 16%
Externalizing 19% 26% 7%

* Attention deficit disorder.

Unlike other psychiatric diagnoses, we diagnosed psychosis in children with CPS

not CAE, and made this diagnosis in less than 10% of these children. However, a
long-term follow-up study of children following hemispherectomy for early onset
intractable epilepsy, most of whom had mental retardation, demonstrated psychosis
in 33%. We also diagnosed autism and autism spectrum disorders infrequently
in the CPS and CAE groups with average IQ in contrast to the high rate of these
disorders in children with epilepsy with mental retardation.

> Read full chapter

Clinical examination of psychiatric pa-

tients
Pádraig Wright, ... Michael Phelan, in Core Psychiatry (Third Edition), 2012

Speech
The patient's speech is observed throughout the psychiatric interview and verbatim
examples of speech should be recorded in order to illustrate the symptoms described
below and in order to note the content of conversation which may reflect underlying
psychopathology. Speech may be abnormal in quantity, rate, volume and/or tone.

The quantity of speech is typically reduced in depressed patients, who may not
initiate conversation and may respond to questions with monosyllabic answers.
Severely depressed patients may be mute. The rate of speech is also frequently
reduced in depression, such that long pauses occur before an answer is made, as well
as between words and sentences, and words are spoken more slowly than is usual. In
contrast, manic patients speak spontaneously and rapidly, the quantity of speech is
greatly increased, and jokes and puns are frequent. Patients with schizophrenia may
exhibit an increased or reduced quantity and rate of speech, while anxious patients,
especially those with obsessive–compulsive disorder, often answer with excessive
detail.

The volume of speech is increased in mania and reduced in depression, and sighing
is also characteristic of depression. Normal speech is characterized by considerable
variation in the tone of voice cadence, but this is reduced or lost in depressed patients
who therefore speak monotonously.

In addition to the relatively measurable quantity, rate, volume and tone of the
patient's speech, the doctor should also note neologisms (characteristic of schizo-
phrenia), thought disorders such as derailment, word salad and verbigeration (which
are also features of schizophrenia), and punning, clang associations and flight of
ideas (mania). Poverty of the content of speech occurs in schizophrenia and is
characterized by seemingly normal conversation that imparts very little information.
Finally, perseveration, dysphasia and dysarthria may be apparent and are suggestive
of organic pathology.

> Read full chapter

Psychiatric Assessment of Liver Trans-

plant Candidates
Elisa A. Moreno, ... Tara McCoy, in Transplantation of the Liver (Third Edition), 2015

The Role of the Transplant Psychiatrist

The transplant psychiatrist conducts an extensive clinical psychiatric interview (Table
30-1) that encompasses past and present psychiatric history, including outpatient
psychiatric treatment, inpatient psychiatric hospitalizations, suicidality, symptoma-
tology, pharmacotherapy, and counseling. A history of depressive disorders, anxiety
disorders, including posttraumatic stress disorder, and substance abuse, including
drugs and alcohol as well as prescribed opioid medications, is common in patients
presenting for liver transplantation. Pain disorders are among the many medical
conditions common in this population as well. Cognitive impairment due to he-
patic encephalopathy complicates the assessment of the patient presenting for liver
transplantation. A family history of psychiatric disorders increases the patient’s risk
for a psychiatric disorder. A history of nonadherence with medical recommendations
alerts the psychiatrist to the potential for future nonadherence. Maladaptive coping
skills are also a risk factor for a poor medical outcome (Table 30-2).

When the transplant psychiatrist elicits history that warrants further investigation,
such as psychiatric diagnostic clarification or neurocognitive assessment, a neu-
ropsychiatric evaluation with psychometric testing tools is recommended. Identif-
ication of maladaptive personality traits, occult psychiatric symptoms, and degree of
cognitive impairment can guide further recommendations. However, these types of
assessments are not sufficient for diagnosis and should be used to complement the
clinical medical evaluation performed by the transplant psychiatrist. Transplant-spe-
cific scales have been created to help assist transplant teams in identifying areas of
concern. The Transplant Evaluation Rating Scale7and the Psychosocial Assessment of
Candidates for Transplant scale8 rate the patients on family support and availability,
past psychiatric history, coping, substance use, adherence history, and knowledge
about transplantation. However, the predictive validity of these scales is unclear.8

Historically there has been variability across transplant centers,5 as well as between
heart, liver, and kidney programs,9 regarding certain psychiatric selection criteria.
Mental retardation,10 active schizophrenia,11 criminality, and methadone mainte-
nance therapy1 have been and continue to be exclusion criteria in some cases.
However, with the advancement of medical knowledge and improved treatment
options for patients, as well as the ethical imperative to consider each case on an
individual basis, the boundaries of what is considered acceptable risk are being
propelled to new frontiers.

> Read full chapter

Psychological Evaluation and Testing

Leslie J. Heinberg Ph.D., Jennifer A. Haythornthwaite Ph.D., in Essentials of Pain
Medicine and Regional Anesthesia (Second Edition), 2005

Measures of Psychopathology:
In addition to assessing the presence of psychopathology during a psychiatric
interview, psychologists often administer self-report instruments of psychopathol-
ogy to patients with chronic pain. Unlike interview data, these measures provide
standardized, reliable, and valid assessments of psychopathology that may influence
the experience of pain. The Minnesota Multiphasic Personality Inventory (MMPI) is
the psychological instrument most commonly used to evaluate the psychological
status of patients with chronic pain. A revised version, the MMPI-2,32 has been
introduced which, like the original MMPI, includes ten clinical scales which assess
psychopathology and three validity scales. The MMPI has been shown to differentiate
samples of rheumatoid arthritis and low back pain. However, it has been criticized
due to its length (566 items), frequency of items relating to physical symptoms, and
lack of predictive validity among populations with chronic pain.33

Shorter inventories, such as the 90-item Symptom Checklist-90-Revised (SCL-90-R),34

have been utilized to assess psychopathology among chronic pain patients. The
SCL-90-R assesses 9 different types of psychological disturbance and yields 3 global
measures of distress. Although often favored for its briefer length and, because of its
focus on symptoms, less patient resistance, it also has not demonstrated predictive
validity with regard to treatment outcome.

> Read full chapter

Clinical assessment
David Cunningham Owens, ... Richard Davenport, in Companion to Psychiatric
Studies (Eighth Edition), 2010

Conclusions
A formal psychiatric interview should have a formal conclusion. This is not so
much a statement or question – and is certainly not merely the passing on of a
prescription! This is a section in itself, in which the doctor will, for initial contacts,
provide some discussion of the problems as he/she sees them, including therapeutic
recommendations, or for follow-up contacts, some assessment of progress and
recommendations regarding on-going management. It is therefore important in
busy out-patient settings that information gathering allows sufficient time for this
crucial exchange.

Ultimately, the examiner determines the structure and duration of most psychiatric
interviews, but with skill and a competent exercise of control over process elements,
they should nonetheless have allowed the patient ample opportunity to present the
issues of importance to them. This cannot however be guaranteed, and especially if
the patient has preconceptions that have not been fulfilled, they may still feel there
are significant areas that remain unaddressed. It is therefore often useful after
concluding the above to give them the opportunity to note this, for example:

‘We've covered a lot of issues during the interview. Are there any other issues we
haven't covered that you feel it would be important for me to know about?’

Alternatively, a useful signal to the patient that the information part of the exercise
has been completed is to say:
‘I've asked you a lot of questions. Are there any questions you would like to ask me?’

Most individuals will not take this as an opportunity to ask about what's to come –
i.e. treatment issues – but will relate it back to what has been before, to whether or
not they are satisfied with what you have asked about. Thus, it can act as a useful way
of linking what has been established with what you will then be recommending.

A final and useful question relates to patient expectations. One of the most powerful
determinants of efficacy for any psychiatric intervention is the patient's belief in
it. One will experience opposition, if not hostility, if one's recommendations are
predominantly pharmacological when the patient's expectations were psychother-
apeutic – and vice versa. Awareness of the patient's expectations is important in
helping to frame recommendations sensitively, especially when they may not gel
with what was anticipated. One might ask:

‘In what way do you feel I might help you?’

or

‘What do you feel might be the best way forward?’

In concluding the interview, the psychiatrist's task is to provide an ‘assessment’,

not a ‘formulation’ (too theoretically burdened) nor a ‘summary’ (too stark), a task
relevant to both initial and follow-up interviews, though slightly different for each.
The patient may wish a diagnosis, and if available with reasonable probability of
accuracy, as with many non-psychotic disorders, it should be offered. However,
many patients, especially those presenting with psychotic disorders, may not wish a
diagnosis at an early stage. This is perhaps as well, because all that one may strictly
be able to offer is a set of differential possibilities, which may be interpreted as lack
of competence! Relatives may of course have profound interest in the outcome of
the interview, and while every effort should be made to inform them – including the
limitations imposed by cross-sectional evaluations – this must be within the bounds
of patient confidentiality.

In appraising material from psychiatric interviews there are two ‘rules’ worth ap-
plying. The first, to paraphrase Kendell (1975), is what might be called the ‘Rule of
Intersubjective Certifiability’. While the central role of empathy in the conduct of the
psychiatric interview has been emphasised, this must be rejected when it comes
to evaluating the material comprising the MSE (with the exception of depth of
emotion). As much of the mental state exam as possible must be submitted to
objective appraisal, such that other examiners would reach similar conclusions to
oneself. Not only must empathy be banned from the diagnostic process, so too
should intuition, identification and any of the interminable dynamic ‘insights’ so
beloved of experts with Sunday supplement expertise. Possible roads to the disorder
should be addressed after the disorder has been diagnosed, and that may include
 psychodynamic ones, but these principles should have no place in the diagnostic
process itself.

The second rule might be called the ‘Rule of Counter-Intuition’. It is everyday experi-
ence that, in all of us, unpleasant life circumstances produce unpleasant emotional
consequences. However, what may be intuitive in relation to everyday life may
not be so in relation to psychiatric disorder. It is well established that disordered
mental states can themselves produce adverse life events – that is, that life events
may bear a ‘dependent’ or an ‘independent’ relationship to psychiatric illness. The
situation where psychiatrists have satisfied themselves that an event bears a causative
relationship to the symptomatology they have elicited is one in which the principle
of refutation should be invoked. Rather than accepting that ‘The event caused
the illness’, the question ‘Could the illness have caused the event?’ must be put
forward for consideration. It is surprising how often ‘intuitive’ impressions fail to
be sustained!

The reader will have noticed the recurrent use of ‘recommendation’ in this chapter
and when it comes to proposing treatments, this word cannot be ‘recommended’
too strongly! While in psychiatric practice, ‘recommendations’ must sometimes be
imposed, in the majority of instances the patient must be the willing recipient of
professional advice. With its connotations of professional authority yet personal
choice, it is the essence of what clinical practice is about.

> Read full chapter

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