WHITE OAK, MD – 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.
“That means there must be coordination of care across providers, and it must be seamless,” he said.
[See also: PCMH model focus of new FQHC demo project.]
To help physicians understand and transform their practices to a medical home, ACP has developed a Web-based program called Medical Home Builder. It has 12 modules to assist clinicians, including how to organize their practice, work as a team and communicate with patients, coordinate across providers and settings.
Each module has a practice "biopsy," which presents a series of questions aimed at determining how effectively the practice provides or does not provide patient-centered care. ACP also has a library of tools and resources for physicians to help them achieve that.
Both physician executives emphasized the importance of effective communications skills, which research has found correlates with better patient outcomes. It can start with activities such as taking detailed medical histories and helping patients understand their conditions, encouraging them to ask questions and giving clear information about decisions to be made about their care.
In addition to communications, Weinberger said patient-centered care also incorporates:
- Whole person orientation
- Shared decision-making with the patient
- Continuous quality improvement and patient safety
- Seamless accessibility to patient information while maintaining confidentiality and interoperability among electronic health records systems
- Accessibility to care when the patient needs it in a timely fashion, and moving from business hours to 24/7 accessibility.
