The "presentation of the patient": The evolution of a practice, its objectives, and its effects on training

Objectives. - Through a review of the history of patient presentations and changes to this system, we will try to situate its function and challenges, particularly with regard to its effects on the training of professionals. The articulation of these effects with the necessary ethical questions raised by this practice will be highlighted. Method. - The review of the French-language literature on the practice of patient presentations makes it possible to note its permanence since the origins of psychiatry, its multiple challenges, the risks it has encountered over the course of its history, and the consequent changes that have resulted from it. A personal experience of patient presentations at the Centre Hospitalier Sainte-Anne over more than twenty years allows us to emphasize the essential elements of this exercise. Results. - Practiced mainly in recent years by psychoanalysts, the system of patient presentations has been considerably modified by taking into account the registers of language, speech, and the transference. The control or supervisory dimension also becomes a central function of this practice. This subversion makes it possible to significantly advance the controversies that run through its history. It also highlights its instructive effects, which, far from being limited to a pedagogical demonstration to inexperienced practitioners, involve practitioners in a place that allows them to question their position as well as their action, in their daily practice. Discussion. - The diversity of patient presentation systems, the variety of circumstances that led to their implementation in hospital services, the variable place they occupy in the organization of care, and the unequal interest that they can arouse on the part of healthcare teams justify identifying the essential benchmarks that make this practice so specific. The articulation of the three distinct places of the patient, the examiner, and the public through the distinct knowledge attributed to each of these places - makes it possible to propose a reading of the structure of these presentations to examine their effects on the training of practitioners, as well as on clinical research. Conclusion. - If clinical practice is developed and transmitted "at the patient's bedside" and in the dialogue between practitioners, then the presentation of the patient is one of the key places where clinical practice is developed. The ethical questions it raises thus constitute an opportunity for a renewal of the psychiatric clinic and its practice. (C) 2019 Elsevier Masson SAS. All rights reserved.