ABSTRACT
Consideration of contextual factors in clinical practice is a hallmark of the patient-centered clinician. Proximal factors correspond most closely with the immediate and specific categories, and distal contextual factors are more closely aligned with the general and metacontext categories. Proximal factors include family, financial security, education, employment, leisure, and social support. Distal factors include community, culture, economics, health care system, sociohistorical factors, geography, the media, and ecosystem health. These correlate with general context and meta-context. Community-oriented primary care has been recognized as a method of informing and integrating the practice of medicine with knowledge of the community. Being patient-centered involves being aware of the many layers of contextual nuance in which both patient and clinician reside. In arriving at a shared understanding or common ground, meaning can only occur within a particular set of circumstances or context.
