Transcript The Physician Charter Principles include

Doctor-Patient Relationship
and Medical Professionalism
Holly J. Humphrey, MD
Dean for Medical Education
The University of Chicago Pritzker School of
Medicine
Framing the Issue
The Physician Charter
Principles include:
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Primacy of patient welfare
Patient autonomy
Commitments include:
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Honesty with patients
Patient confidentiality
Maintaining appropriate relationships with patients
ABIMF, ACP, EFIM 2001
ACGME Competencies
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Patient Care
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
Systems-Based Practice
ACGME Outcome Project, 1999
Framing the Issue
• Seven Essential Elements in PhysicianPatient Communication
– Build the doctor-patient relationship
– Open the discussion
– Gather information
– Understand the patient’s perspective
– Share information
– Reach agreement on problems and plans
– Provide closure
Bayer-Fetzer Conference on Physician-Patient
Communication in Medical Education, 1999
Etiquette Based Medicine
Checklist for first meeting with a hospitalized
patient:
• Ask permission to enter the room; wait for an
answer
• Introduce yourself, showing ID badge
• Shake hands (wear gloves if needed)
• Sit down. Smile if appropriate
• Briefly explain your role on the team
• Ask the patient how he/she is feeling about
being in the hospital
Kahn MW, N Eng J Med, 2008
Doctor-Patient Relationship Linked
to Outcomes of Care
• Sustained physician-patient partnerships
with bonds of trust and knowledge of
patients were correlates of three outcomes
of care
– Adherence
– Satisfaction
– Improved health status
Safran DG et al, J of Fam Practice, 1998
Example
The University of Chicago FACE
Card Program
The University of Chicago FACE
Card Program
BACKGROUND
 Patients admitted to
academic teaching
hospitals are often cared
for by teams made up of
multiple physicians at
varying levels of training.
Potential for confusion,
possible
misrepresentation.1.2
 Patients are in a unique
position to evaluate the
professional behavior of
their inpatient physicians.
OBJECTIVES
 To help patients identify
and evaluate their
inpatient physicians.
 To collect patient
evaluations of the
professional behaviors of
their inpatient physicians.
Description: FACE Cards
Side 1
Comments
University of Chicago
Hospital
General Medicine Service
Dr. Brian Callender
Medical Intern
Dr. Brian Callender
Medical Intern
Description: FACE Cards
Side 2
Evaluation Key
Communication- How well did this person
communicate with you and your family?
Did they offer to answer your questions?
Rate from 0 to 100…
1. Communication
SCALE
100-Best Possible
90-Excellent
Compassion- Was this person sensitive to your
and your family’s needs?
2. Compassion
80-Very Good
70-Good
60-Above
Average
Respectfulness- Did this person ask and respect
your choices about your care?
50-Average
3. Respectfulness
40-Below
Average
30-Poor
Responsibility- Did you feel this person acted
appropriately on your behalf?
20-Very Poor
4. Responsibility
10-Terrible
0-Worst Possible
FACE Card Procedure
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During attending rounds for new
patients, the team members place
their card in the corresponding
spot in the plastic card holder.
Team members give card holder
to the patient and explain the
project to the patient, asking him
or her to rate the physicians.
FACE Card Procedure
• FACE envelopes used for the collection of FACE
cards are placed in patients’ charts in front of
discharge papers by unit secretaries.
• Reports for physicians are generated from
completed evaluations.
• Reports go into a portfolio for viewing by trainee
during structured quarterly feedback session with
PD or chief.
Sample Comments
• “This doctor made such an impression on me that I’m
now going to switch her for my primary doctor. She was
everything a successful, caring doctor should be…. I feel
like I just found the most perfect doctor.”
• “Excellent young doctor. Very caring and sweet!”
• “While I believe this doctor cared for me excellently…
most of the time I felt I was in the dark about what was
happening. I never had a chance to ask questions until
the end– mostly because everyone was always in such a
hurry to get away.”
AAMC Survey: Curricular Content
1980
2000
Communication
47%
80%
Geriatrics
82%
95%
Death/Dying
96%
Cultural
Competence
70%
AAMC Medical Education’s Quiet Revolution
“I want the doctors of tomorrow to know that
when all the formal teaching is over and I walk
into your office my need is for medical care for
my child, but my desperate hope is that you
have the same stake in my child’s health as I
do.”
J. Schlucter
Mother of 2
Both children with cystic fibrosis