Mary Mosquera, Senior Editor
Mary Mosquera is a Washington, D.C.-based Senior Editor who covers healthcare policy, business and technology issues for all MedTech brands. Follow Mary on Twitter @GovHITreporter.
Physicians must learn how to put patients in the center
WHITE OAK, MD | December 2, 2011
Physicians need to learn "patient-centeredness" as one of their core medical skills so they can incorporate it into their daily practice. But many clinicians are unfamiliar with what is involved in practicing with the patient at the center of his or her care, despite it being a foundation for improved quality and new delivery models.
Some physician professional organizations are stepping up to offer teaching aids about patient-centered care.
Patient-centeredness should be a part of education in medical schools, training for residency and included within competencies for certification and re-certification, according to physician executives of professional organizations.
[See also: Patient-centered healthcare is essential healthcare.]
To be certified by the American Board of Internal Medicine (ABIM), physicians must demonstrate medical knowledge, patient care and procedural skills, interpersonal communication skills, professionalism, systems-based practice and practice-based quality improvement, said Eric Holmboe, MD, chief medical officer for the ABIM. Patient-centeredness fits into all these competencies.
"We have to empower the physicians to have the competencies to help patients elevate their own competencies,” he said at a Nov. 29 conference on patient-centeredness in policy and practice sponsored by ECRI Institute, a healthcare quality and patient safety researcher, and the Food and Drug Administration.
The healthcare system should be helping patients to acquire the literacy to understand risk and to advocate on behalf of themselves, so they can make good decisions to manage their care, especially those with chronic diseases, Holmboe said.
“Patient feedback on their experience and satisfaction can be used as part of the certification process,” he added.
ABIM offers online practice improvement modules for physicians and residents based on surveys of dozens of patients and their experience with care they received at office-based practices. The surveys show where clinicians can make changes that are meaningful to patients.
Surveys are useful when they capture patients’ experience and how it relates to their quality of care and outcomes and functional status, Holmboe said. Patients who had better experiences with their providers were more likely to adhere to their treatments, which may yield better results, such as in high blood pressure control and diabetes control.
“It’s hard to practice patient-centered care without the patient’s voice,” he said.
The system of care delivery is changing from “an individual based sport to a team-based sport,” said Steven Weinberger, MD, executive vice president and CEO of the American College of Physicians. Patient-centeredness is the key to the medical home model.
Showing 7 Comments
Peter Jones say: Person-centered care - a free gyroscope....
December 03, 2011 | 08:24 AM GMT
As anyone working with older adults knows a patient's orientation is crucial to assessment and subsequent, planning and intervention. Clinicians also need to be oriented to ensure a relevant and wholistic assessment and care plan that is relevant to the person.
Hodges' model is a free, open access conceptual framwork developed in health and social care that can help assure person-centered care and facilitates lifelong learning. The blog "Welcome to the QUAD"
http://hodges-model.blogspot.com/
- has many posts tagged accordingly:
http://hodges-model.blogspot.com/search/label/person-centred
The model's four care (knowledge) domains each feature a unique education and informatics resource listing, e.g. SCIENCES:
http://www.p-jones.demon.co.uk/linksTwo.htm
SOCIOLOGY - including patient, carer resources:
http://www.p-jones.demon.co.uk/links3.htm
Kind regards.
Peter Jones
Lancashire, UK
Hodges Health Career - Care Domains - Model
http://www.p-jones.demon.co.uk/
h2cm: help 2C more - help 2 listen - help 2 care
http://twitter.com/h2cm
dch say: Semantics and power
December 02, 2011 | 15:30 PM GMT
Concept of patient-centered care … semantics, buzz words.
Organizations armed with new catch phrases, buzz words, programs and educational modules won’t change a widget processing patient mill into a warm caring environment.
At least two things are needed, a doc with a caring, inquisitive, non-god personality, and enough time per patient to actually listen. I’m not quite sure how teachable either is.
Docs who are good at listening don’t need buzz words. Docs who aren't good at listening ... well ... won't listen to the buzz words anyway.
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@ comment re: person vs. patient centered care - I suggest Pinker’s writings re: euphemism treadmills.
Patient is derived from "suffering or sick person," late 14c., from O.Fr. pacient (n.), from the adj., from L. patientem (nom. patiens), prp. of pati "to suffer, endure," from PIE base *pei- "to damage, injure, hurt"
No suffering, or risk of suffering? No need for medical services.
I certainly agree with understanding patients comprehensively in order to better ameliorate their sufferings. Changing the word from "patient" to "person" won't make that happen.
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@ comment re: patient input. “Physicians wield a disproportionate amount of power at the center of the design process.” I’m not convinced physicians have had enough “power” in designing health IT systems as it is. The results show in the awkward quality of the products for which 3-5 DAYS of training are suggested prior to use. Give me a break.
I agree with physicians wielding a “disproportionate share” of such power, should we actually ever have that opportunity. What’s being designed is a set of tools for physicians to use to help care for patients. Patients are not the primary end users. They are the beneficiaries. End users should have a say in how their tools are designed.
Mary Powell say: patient centeredness
December 02, 2011 | 13:43 PM GMT
The following is an example of a recent scenario and typifies what is NOT patient or person centered care and was related anecdotally to me as I am also a provider.
A daughter is becoming concerned about some behavior changes noted in her 80 year old mother. The daughter has acquired the appropriate HIPAA approval for discussion with the physcian about her mother and askes for an inperson appointment for which she is willing to pay out of pocket for time spent. Instead the physcian calls the daughter at her workplace and says you don't need an appointment. "Your mother has Alzheimer's and needs to be assessed at...and you need to have COSA come to the house" ...and so on.
This conversation took place without the physcian asking if the daughter was in a position to talk safely and privately. Moreover, this conversation took place without any use of evidence for "breaking bad news". Finally, this conversation was filled with medical jargon and abbreviations.
We can give all the lipservice to patient centered care but until anecdotes such as noted above stop, that is all we have...lipservice.
Gary Christopherson say: Person-centered rather than patient-centered
December 02, 2011 | 13:03 PM GMT
The health and health care field continue to make the same mistake. It should be person-centered rather than patient-centered if we are really going to improve health and we want a partnership with the person whose health we are trying to improve.
If our vision is to truly improve health, then we need to start out with the right framework. The right framework is "person-centered" health rather than the more limiting "patient-centered" term. "Person-centered"
incorporates the person's whole life (rather than just when they are "sick"), brings in prevention, taps into the full health community (rather than just formal health care providers), addresses human behavior, and understands that improving health requires dealing with a broad set of factors (e.g. income, education, housing, food).
At the core of health improvement is a collaborative partnership between the person and the key health providers/supporters (broadly termed).
In the end, improving health is dependent on improving the related behavior. This comes down to health providers/supporters who understand the role of human behavior and know how to partner with the person to improve the key behaviors (better life style, adherence to treatment,
etc.) that result improved health outcomes and status.
Gary Christopherson, www.HealthePeople.com
For more, go to www.HealthePeople.com or read Gary Christopherson, “HealthePeople: Person-Centered, Outcomes-Driven, Virtual Health System” in Person-Centered Health Records - Toward HealthePeople. Health Informatics Series, Springer Science+Media Inc.
Glen say: Putting Patients in the Center
December 02, 2011 | 12:18 PM GMT
It seems to me that the Health IT establishment could do a much better job of putting patients into the center of health applications. Saying that physicians must learn how to put patients in the center is not enough, especially if their automated assistance is not supporting and encouraging it.
Gerald Wieder say: Patients at the center
December 02, 2011 | 12:37 PM GMT
Physicians most often have seat at the table when designing health applications. Patients do not. Physicians wield a disproportionate amount of power at the center of the design process. Patients do not. Organizations build access (usually some kind of web portal) for the physicians, long before they consider patient portals. This from someone who's been working in the "Health IT establishment" (whatever that is) for the past 10 years.
Ashley Boyd say: Empowering the patient through televideo
SBR Health believes that connection is the best medicine and was developed in support of the patient-centered medical home. Through our real-time video communications platform, we're working to reduce readmissions and increase access. Our focus is to improve the quality and delivery of care with patients in mind.
As geographic distance, lack of transportation, physical disabilities and other limitations can make it difficult for patients to attend scheduled doctors' appointments. Through remote video consults, video triage and post-discharge follow up, SBR Health is enabling major health delivery organizations to provide better care coordination to assure patients are receiving the highest quality of care.
Our solutions provide the following:
-Provide patients a way to attend their sessions without leaving their home
-Give patients the tools to take a more active role in their treatment
-Allow medical professionals to more easily reach remote patients, who typically can not access care
-Help prevent cancellations and manage unscheduled session requests through televideo communications
-Provide a way to remotely triage patients without necessitating hospital visits
-Measure success through reduction in emergency visits and cost savings as a result of more efficient scheduling