Wednesday, September 30, 2009

Arch's suggestions on how clinicians can best partner with patients

Arch M, a wise and spunky 86 year old physician contiributor to the mpdchat group that I belong to, posted the following suggestions for clinicians on how to develop partnerships with patients (please note - I took the liberty of editing these a bit):

"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!!!

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