Transcript Session 1 HINF 371

Patient Provider Relationship
HINF 371 - Medical Methodologies
Session 19
Objective
To review the requirements of
effective patient provider relationship
 To discuss how technology can
contribute to enable this effective
relationship

Reference

American Healthways and John’s
Hopkins (2003) Defining the PatientPhysician Relationship for the 21st
Century.
www.healthways.com/articles/
outcomes/PatientPhysician.pdf
Principal Elements of
Relationship
Communication
 Office Experience
 Hospital Experience
 Education
 Integration
 Decision-making
 Outcomes

Does This sound Familiar?
It has been way too long since
you’ve been in to see me.
I understand that it can be, but it is
very important that you come in
regularly
We’ll set a longer
appointment
time. Are you taking your
medications as prescribed?
Exercising regularly?
Do you have any idea how hard
it is to get an appointment?
OK, but can you guarantee that
we will have more time to really
discuss what is going on with
me?
Uh…not really. I hate pills!
Uh…no.
Symptoms of the Disease…
Fewer providers + managed care = less
access for patients
 Greater life expectancy + life “excesses” =
more patients with chronic disease = more
encounter time required
 Healthcare consumerism + technology =
information overload
= BREAKDOWN OF THE PATIENT-PHYSICIAN
RELATIONSHIP

Don Caruso, MD – Associate Medical Director
Mike House – Chief Information Officer,
Cheshire Medical Centre)
Communication





All parties should acknowledge patients as most
knowledgeable about their symptoms
Patients should provide feedback and Physicians
should welcome feedback
Physicians should implement a social
questionnaire as part of their initial intake
Role of patients’ gender, age, race and religion
must be recognized
Traumatic news must be delivered appropriately
Communication




Patient’s designated advocate must be respected
and included in care relationship
Physicians provide current, scientifically based
“best medical practices” in an ethical and timely
fasion
Patients should seek – physicians should promote
– active, collaborative discussions with patients
Relationship must mirror our daily lives by relying
on methods of communication that are not limited
to inflexible, one-on-one visits
Office Experience





Patients should be able to access healthcare in a timely
fashion (assuring flexible access is also essential)
Details of office practices and procedures should be
available in written form
Physicians and their staff should review medical
information form periodically to help minimize duplication
of information and the consequent burden on patients
Physicians office staff should be polite, professionals and
well-trained to facilitate the care experience
Telephone communication between patients and office
should be designed to be effective and efficient and avoid
frustration and overload
Office Experience





Physicians should continually evaluate their
scheduling systems for effectiveness
Office visits should be used as opportunities to
review care plans
Both patients and physicians make effort to be on
time for appointments
Both patients and physicians enter appointment
prepared.
There should be sufficient redundancy to absorb
unexpected events
Office Experience
A responsive and effective system for
referrals is essential
 Physicians should communicate to patients
the value of regular, face-to-face medication
reviews

Hospital Experience





Healthcare team should attempt to personalize care in
the hospital
Which physician in charge of care – and that
physician’s role – should be clearly defined to the
patient
Effective communication is imperative to avoid errors
Prior to procedures, patients must be effectively
educated
Communication with the family, as approved by the
patient, should be coordinated by a designated family
member or advocate
Hospital Experience





Physicians should ensure comprehensive discharge
planning
Patients should make sure that their discharge information
or inpatient records available at outpatient setting
Caring and attentive emergency room staff and timely
evaluations are vital
ER staff should communicate to the patient’s responsible
physician all arrangements for follow-up care and details
of the particular visit
A strong patient-physician relationship should ensure that
the emergency room is used for “true emergencies”
Education





Physicians and patients must work as partners to
create an ever-evolving self-care program
Education should address physician-patient
knowledge differences, culture and language
Each patient should receive a tailored education
package
Physicians should be open to education by patient
Physicians should discuss with patients the risks
associated with prescribed treatment
Education





Physicians should furnish patients with
educational materials or resources
Physicians should familiarize themselves with and
incorporate guidelines into treatment plan
Patients should incoporate guidelines into their
self-care programs
Patients should share with physicians any outside
information with providers involving changes to
the prescribed treatment program
Physicians should remain objective when
reviewing outside information
Integration





Physicians or their staff should facilitate patients’
movement through the system in a prompt and efficient
manner
Patients who schedule their own appointments should
recognize their responsibility to inform primary physician
Physicians, with patients’ consent, provide information
promptly to other care providers
Both patients and physicians recognize that EMR is the
optimal method for having shareable medical information
Patients should share their own personal medical
information with care providers
Integration
If EMR is not available, patients should
have a copy of their all test results
 Physicians must remain abreast of specific
formularies and coverage of medications

Decision-Making





In decision making process, physicians should consider
patients’ personal, religious, economic and psychosocial
factors, as well as clinical
Physicians are obliged to see that patients receive
sufficient information and patients are obliged to educate
themselves to be able to ask questions and understand
the consequences of the decision
Physicians and patients should explicitly define and discuss
realistic expectations
Patients have right know all of their options regardless of
physician’s beliefs, values and interests
Patients have the responsibility to fully disclose their
adherence to recommendations
Decision-Making
Role of advocates must be identified
 Patients should write down their
preferences of care

Outcomes




Clinical or disease specific: patients and
physicians should understand and discuss
clinical practice outcomes
Patient-centred outcomes: Physicians
should appreciate patient-centred
outcomes as valid objectives
Physician-centred outcomes must be
objectively defined and advocated in the
health system
Self efficacy of patients is a common
outcome.