Transcript Why Join AMSA?

Physician Communication Skills for PatientCentered Care
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Define the key elements and benefits of
patient-centered care
Identify cultural, health literacy, and other
barriers to effective patient-physician
communication
Apply several communication skills to achieve
patient-centered care
“Patient-centered care encompasses qualities
of compassion, empathy, and responsiveness
to needs, values, and expressed preferences
of the individual patient.”
– Institute of Medicine Crossing the Quality Chasm: A New Health System
for the Twenty-first Century
Crossing the Quality Chasm: A New Health System for the Twenty-first Century
Rules to reach quality…
Quality healthcare should be…
Safe
Effective
Patient Centered
Timely
Efficient
Equitable
Care is based on continuous healing
relationships
Care is customized according to
patient needs and values
The patient is the source of control
Knowledge is shared and
information flows freely
Decision making is evidence based
Safety is a system property
Transparency is necessary
Needs are anticipated
Waste is continuously decreased
Cooperation among clinicians is a
priority
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Increased patient satisfaction
Increased patient compliance
Improved self-reported health status
Improved outcomes in physical and mental
functioning
Key Study: Patients’ perceptions of
patient-centered communication
associated with better recovery,
better emotional health, and fewer
diagnostic tests and referrals.
(Stewart et al, 2000)
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Positive communication, empathy, and
patient-centered interactions associated
with decreased likelihood for litigation
Key Study: Quality of medical care
poorly correlated with occurrence of
malpractice suits.
(Entman et al, 1994)
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Increased patient satisfaction linked to
patient loyalty and re-use of services
For institutions  Increased patient volume
and profits
Key Study: For physicians rated lowest
in participatory decision-making, 1/3
patients changed doctors in following
year, versus 15% for high participatory
decision-making.
(Kaplan et al, 1996)
Knowledge of symptoms
Unique Family Situation
Needs & Desires
Lifestyle
Shared Decision-Making
Improved Outcomes
• Patient Satisfaction
• Patient physical and
mental health
Cultural Traditions,
Personal Values
• Patient compliance
• Patient retention
Compassion
• Physician/practice
profits
Clinical Knowledge
Respect of patient
Responsiveness
Communication Skills
• Physician satisfaction
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Increased patient and physician satisfaction
Increased patient compliance
Improved outcomes in physical and mental
health of patients
Key Studies: According to two
studies, 20-25% of patients who
change physicians do so because
they are dissatisfied with physicianpatient communication.
(Jackson, 2001)
◦ Provide clear information, based on
patient’s desire for details
◦ Mutually agree upon goals for shared
decision making
◦ Convey empathy and compassion, verbally
and nonverbally
◦ Respect and respond to patient’s values,
beliefs, needs, and emotions
“The degree to which individuals have the
capacity to obtain, process, and understand
basic health information and services needed
to make appropriate health decisions.”
– Department of Health and Human Services
Institute of Medicine Health Literacy: A Prescription to End Confusion
Below Basic – 30 Million
Circle date of a medical appointment
on hospital appointment slip.
Below
Proficient
Basic – 47 Million
Explain why difficult to know if people
have specific chronic condition, based
on article.
Intermediate – 114 Million
12%
Intermediate
53%
Basic
Basic
14%
22%
Determine time to take medicine based
on drug label.
Proficient – 25 Million
Find information to define medical
term, based on complex document.
Data from the 2003 National Assessment of Adult Literacy
Less frequent use
of preventive
services
Inability to
manage chronic
conditions
Higher rates of
hospitalization
Higher costs to
healthcare
system
Communication the patient can understand
the first time they hear it –
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Use simple language
Explain with everyday
examples
The heart is like a pump, but
the tubes the blood goes
through can get clogged
Ask patient to restate information in their own
words, or to demonstrate understanding of
key concepts.
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I want to be sure I went over
everything. Tell me when
you will take this medicine.
Just to make sure I was
clear: show me how you will
use your inhaler.
“A set of academic and personal skills that
allow us to increase our understanding
and appreciation of cultural differences
between groups.”
- National Health Service Corps Education Program for Clinical and
Community Issues in Primary Care
Patient’s…
Values and beliefs
What is considered to be health
problem
How symptoms are expressed
Who should provide treatment
for the problem
What type of treatment should
be given
Doctor’s…
Assessment and diagnostic
protocols
Communication styles
Treatment and interventions
Health education and
counseling
Consulting with traditional
healers
Listen with sympathy and understanding to
the patient’s perceptions of the problem
Explain your perceptions of the problem
Acknowledge and discuss the differences and
similarities
Recommend treatment
Negotiate treatment
Berlin & Fowkes, 1983
Listen with sympathy and understanding to
the patient’s perceptions of the problem
 What do you think caused your
problem?
 What do you fear about your
sickness?
 What kind of treatment do you
think you should receive?
Kleinman et al, 1978
A 29-year-old African-American woman with three
days of abdominal pain and fever was brought to
a Baltimore emergency department by her family.
After a brief evaluation she was told that she
would need an exploratory laparotomy. She
subsequently became agitated and demanded to
have her family take her home. When approached
by staff, she yelled “I came here in pain and all
you want is to do is an exploratory on me! You
will not make me a guinea pig!” She refused to
consent to any procedures and later died of
appendicitis.
Institute of Medicine, 2004
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Berlin, E. A. Fowkes, W. C. (1983). A Teaching Framework for Cross-cultural Health Care. The
Western Journal of Medicine, 139(6): 934-938.
Clark, P. A. Drain, M. Malone, M. P. (2005). Return on Investment in Satisfaction Measurement
and Improvement. Press Ganey Associates, 1(2).
Entman, S. S. Glass, C. A. Hickson, G. B. Githens, P. B. Whetten-Goldstein, K. Sloan, F. A.
(1994). The relationship between malpractice claims history and subsequent obstetric care.
JAMA, 272(20): 1588-1591.
Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the Twentyfirst Century. Washington: National Academies Press.
Institute of Medicine (2004). Health Literacy: A Prescription to End Confusion. Washington, DC:
Institute of Medicine, Board on Neuroscience and Behavioral Health, Committee on Health
Literacy.
Kaplan, S. H. Greenfield, S. Gandek, B. Rogers, W. H. Ware Jr., J. E. (1996). Characteristics of
physicians with participatory decision-making styles. Ann Intern Med, 124(5): 497-504.
Kleinman, A. Eisenberg, L. Good, B. (1978). Culture, Illness, and Care – Clinical Lessons from
Anthropologic and Cross-Cultural Research. Ann Intern Med, 88(2): 251-258.
Kutner, M., Greenberg, E., Jin,Y., and Paulsen, C. (2006). The Health Literacy of America’s
Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–
483).U.S.Department of Education.Washington, DC: National Center for Education Statistics.
Stewart, M. Brown, J. B. Donner, A. McWhinney, I. R. Oates, J. Weston, W. W. Jordan, J. (2000).
The impact of patient-centered care on outcomes: J Fam Pract, 49(9): 796-804
Trotter, Robert T. (1994). Cross-Cultural Issues in Primary Care Module. National Health
Service Corps Education Program for Clinical and Community Issues in Primary Care.
U.S. Department of Health and Human Services. Plain Language: A promising strategy for
clearly communicating health information and improving health literacy. Washington, D.C.
Retrieved July 6, 2010 from
http://www.health.gov/communication/literacy/plainlanguage/PlainLanguage.htm