Wednesday, September 30, 2009
"Patients as partners ...a half dozen things patients expect that I learned at the bedside down through the years and not from the library and lecture room.
1. Treat patients and their families as social equals.
2. Never stand in the doorway to talk. Sit on a chair never on the side of the bed and always sit even if only for a microsecond. Look at the chart, but always do a bit of physical examination.
3. Be an advocate not an adversary, Discuss things that concern the > patient, don't relate the doc's doings. Explain, Explain, Explain and then Explain some more.
4. Make sure that the patient understands what your are doing for them.
5. Listen! Pay attention! Show concern! as if the patient is your brother or sister.
6. Say "don't know" if don't know. Don't hide our failures, share them openly. "
These are fabulous suggestions and fit with what I have learned from "experts" in the field of clinician-patient communication. During my career as a teacher of communication skills, I have been exposed to a many models that have attempted to capture the key ingredients for effective communication. Arch's list is as good as any!
What is interesting about Arch's "Satisfying Six" suggestions - is that the list contains many of the behaviors that have been shown in research studies to be associated with both patient satisfaction and therapeutic outcome!
After thinking about it, and comparing Arch's list with other lists that I have used in my teaching, here are a few other ideas for enhancing patient satisfaction, and improving the quality and outcomes of care:
- Explore the patient's agenda - ask what is most important for them to accomplish during a visit (helps to start out with this step!) Then of course, the clinician needs to give adequate time to meet the patient's agenda!
- Listen with empathy (This is just another way of stating what Arch wrote in #5 when he said "Listen" and "Show concern"). Being empathic and includes letting the person know that you are trying to understand their feelings and concerns by reflecting back the patients emotions.
- Take the time to check to for understanding. Explaining is necessary, but sometimes insufficient, to insure patient understanding, especially when there is a lot to share, and/or the patient is ill or upset
- Respect patient autonomy - offer options, share control, accept the patient's choice, even when you don't fully agree
- Create a safety net - make clear follow-up plans , refer to resources, offer multiple ways to get help
- Link patients to other patient - know about advocacy and support organizations, like mpdchat!!!
Sunday, September 13, 2009
Empathy is flowing....check it out!
Monday, August 3, 2009
The link to the list archives and information about joining the list is: http://listserv.acor.org/archives/mpd-net.html
Sunday, July 19, 2009
In 2005, I was diagnosed with polycythemia vera, a member of the MPD family of disorders. Like other chronic conditions, these disorders are associated with a variety of symptoms that effect quality of life and function. After my diagnosis, I found the list online and have been a regular reader and contributer since. The MPD Support list provides subscribers with an opportunity to ask questions, share knowledge and experience, learn about the latest research and clinical trials, and share support.
I, personally, have recieved invaluable information and suppoprt from other members of the MPD support list. I have also had an opportunity to offer my perspective as a physician-educator. Quite often, members of the list raise concerns or issues about their interactions with clinicians, especially their clinicians. In response to a post about a particularly problematic interaction witha doc, I shared the following post. Visit the listserve at http://listserv.aol.com/archives/mpd-support-l.html to gain insight into the benefits of such online support groups. See also the resources at the end of the post.
Here is my post from July, 2008:
Unfortunately, all too often, we feel unheard, or even worse, dismissed by physicians who don't understand or value the importance of OUR knowledge, expertise, experience regarding our illness. Docs are not only failing to hear, connect and respond to the needs of patients. As Axxxx pointed out, docs who fail to engage and enlist the patient in care miss, or fail to collect, key information that is essential to diagnosis and treatment planning. This problem not only leads to anger, dissatisfaction and other justifiable responses (such as Exxxx's), it also leads to poor clinical outcomes. As a patient, I have had my own share of problematic interactions with docs. On the other hand, I have had some good experiences as well. As a physician and teacher of other clinicians, my whole career has been dedicated to helping students and clinicians to appreciate the importance of using effective communication. We have a long way to go.... but I have not given up on trying.
So, Exxxx (and others)... we (clinicians)... need to hear you.... respect you... appreciate you.... and acknowledge your expertise... as well as respond to your needs. And we (clinicians) also need to take advantage of listserves like this one, as well as other ways in which patients can assist each other to address the problems and needs associated with having a chronic condition. Cxxxx's advice to bring a family member, or other companion, to health care visits is a wonderful idea. It helps to have another set of ears, and an advocate with us to increase the chances that we (patients) will be get needs met and questions addressed.
I have found a couple of wonderful organizations and programs that are striving to enhance patients' capacity to manage their health conditions, as well as their engagement in the process of improving care. See the websites for the Institute for Family Centered Care (www. familycenteredcare. org (http://www.familycenteredcare.org)) and New Health Partnerships (www.newhealthpartnerships.org (http://www.newhealthpartnerships.org)). I have had the pleasure of working closely with both of these organizations and can vouch for their value to patients, clinicians and health care systems. You will find lots of good resources. [Rxxxx.. there may be some ways that we can create links to these sites from our websites].I would love to have the opportunity to serve as a source of support of members of this list who would like help forging effective partnerships with their health care providers. However, the best advice will come not from me, but from other members of this community who can share the strategies that have worked for them. Feel free however to write to me on the list as well as offline (firstname.lastname@example.org)
Michael PV since 1/2006, asa, phlebotomy
Saturday, July 18, 2009
that was linked to a column written by Paulene Chen, MD. Dr. Chen, a transplant surgeon, has a wonderful column, Doctor and Patient, that appears regularly in the NYT. The original column was entitled, Taking Time for Empathy, http://www.nytimes.com/2008/09/26/health/chen25.html
I recommend reading Dr. Chen's columns, as well as the comments available for each column. See also the links listed at the end of my post.
Here is the post:
I hope this does not sound self-serving. My entire professional life as a physican, teacher, researcher, consultant has been devoted to promoting empathy and patient and family-centered care within the context of clinician-patient interactions. I am passionate about empathy.
So, soon after getting an e-mail with a link to Dr. Chen’s moving column, I eagerly read every word of every comment listed here. I found myself resonating with many comments….especially by those of you who were willing to share their stories about their experience as patients and family members.
As Drs. Back, Chen and others have noted in their comments, there is now a growing body of research indicating that empathy matters. Clinician empathy is associated with a range of outcomes including not only patient satisfaction and trust, but also follow-through with medical recommendations and improved health care status.
There is also a growing evidence base indicating that empathy can indeed by taught, at any level, even years after completing professional training. Training is necessary but not sufficient. Even though most schools have courses in clinician-patient communication - I used to help run one - the “hidden curriculum, which refers to negative role-modeling from less enlightened faculty can undermine more formal educational opportunities. As several physicians have mentioned on in this thread, it was the example of their mentors that had the most lasting impression on them. We need more caring, empathic medical faculty (like Drs. Back and Chen) who walk the walk, as well as talk the talk.
I could go on…but I rather read what you all are writing. Thanks so much for this opportunity to read and respond.
BTW, if anyone wants to learn about efforts to teach empathy and other core communication skills to health care professionals see: http://www.healthcarecomm.org/ and http://www.aachonline.org/.
From Pauline Chen: Thank you, Dr. Goldstein, for all your important and hopeful work in this area and for including those links.— Michael Goldstein
Saturday, July 11, 2009
For a long time, I have been been a passionate advocate for patient and family-centered health care and have spent the last 25 years trying to learn, and teach, skills that foster strong clinician-patient relationships. I have been very fortunate to have had many wonderful teachers, mentors, colleagues and patients who have helped me along the way. Though I believe I have become a pretty decent communicator, and some might say a very good teacher, I am humble enough to realize that I still have a lot to learn
In my efforts to enhance my own skills as a clinician and educator, I have hungrily sought out training, scoured the clinician-patient communication research literature, conducted some research myself and experimented with a variety of teaching techniques and formats. Relatively early on in my personal journey as a clinician-educator, I realized that the most basic skills were also the most important. If we can't communicate well, can't connect with patients on a personal level, can't understand the patient's concerns, how can we hope to help them heal, cope and recover?
The most basic skills are linked to what my colleagues and friends Steven Cole and Julian Bird have call the 3 functions, or tasks, of the clinician-patient encounter (which I have adapted a bit):
- Eliciting the patient's story/problems/concerns/needs
- Building a strong clinician-patient relationship
- Developing a shared understanding of the problem/condition and collaborating on a plan for treatment and self-management
Each of these tasks can be accomplished though the use of specific skills....a long list of skills i might add, though some are more basic than others.
Empathy, in my humble opinion, is THE most important and powerful skill that clinicians can employ to enhance communication and forge strong healing relationships with patients and families. Empathy helps us to truly understand the experience of patients so we can ultimately help them. Through empathy, we strive to "stand in another's shoes" and see the world through their eyes. To be truly empathic this requires us to maintain an open heart and an open mind. This is not easy....and requires clinicians to be willing to spend the time it takes to understand, remain relentlessly curious and suspend all judgement. However, the payoff is immense....shared understanding, stronger relationships, and even better diagnosis and treatment outcomes.
So, I continue striving...and learning...and sharing...now here as well.