While it can be challenging to embrace the principles of patient-centeredness, it is also a key quality improvement target, according to a groundbreaking 2001 report on the subject by the Institute of Medicine. The patient satisfaction survey required of hospitals by the Centers for Medicare & Medicaid Services likewise pays homage to patient-centeredness by tracking if patients feel respected, informed and cared for in a timely way.
To be patient-centered is to respectfully listen to patients and render care that is responsive to their individual preferences, needs and values. That may require doubling down on educational efforts to ensure patients understand their options so they make choices that are in their own best interest—especially if they’re misinformed (e.g., want an antibiotic they don’t need), distrustful of physicians, or don’t fully understand the risks of treatment versus the expected benefit. Setting clear expectations for the patient as to the course of their treatment modality, including their role in their own recovery, is imperative.
To move closer to patient-centered ideologies, where care effectiveness is defined collaboratively with patients, here are a few highly effective practices providers may want to adopt:
- Engage patients in a dialogue about the risks and benefits of medical procedures. Practitioners may be overestimating how well they’re doing in this arena, especially if their tendency is to slip into using medical jargon that patients probably don’t understand. To ensure comprehension, clinicians need to speak in plain language about the chances that a medical course of action will be helpful or not, based on patients’ personal characteristics (including risk stratification variables such as weight, age, comorbidities and support system) and the aggregate experience of people like them who have undergone the same procedure.
The prerequisites for a meaningful conversation, and true informed consent, can be numerous. For patients who are “limited English proficient,” for example, federal law requires that you provide a qualified interpreter and translator, free of charge. Those with mild cognitive impairments are going to need some sort of advocate or loved one—even a clinical assistant or nurse in the room to rephrase basic medical terms—to ensure comprehension. Accommodating patients who are elderly and hard of hearing can be as simple as positioning yourself in front of them at eye level as you speak.
All patients deserve your undivided attention—meaning your eyes aren’t repeatedly darting to your cell phone, you’re not interviewing them through the lens of a computer screen (bring in an assistant for data entry) or brusquely asking “Any questions?” as you rush out the door to the next patient. The end goal is to decrease the risk of problems and focus on improving each patient’s quality of life. Invite patients to participate in an unhurried, heart-to-heart dialogue where every concern is perceived as worth voicing (e.g., “I want to make sure I helped you understand everything about this procedure we’re going to do.”).
For all procedures, the risk/benefit ratio also has to weigh in an assortment of non-clinical factors, such as the coverage policies of insurance companies and the patient’s desire for a particular test or treatment.
- Point patients to valid sources of information. Even healthcare professionals can get overwhelmed by ever-changing and sometimes conflicting advice in media reports about what evidence-based medicine would stand behind. Utilizing risk assessment as part of their decision-making process helps clinicians make appropriate treatment recommendations, such as medication and dietary changes (in lieu of implanting a stent) in patients at little to no risk of having a heart attack. It is the responsibility of providers to ensure patients receive the best treatment at the best time and have participated in the decision-making based on information gleaned from scientifically valid studies and trustworthy professional organizations. It is also their duty to teach patients that random postings on Facebook or Wikipedia offering advice may not be backed by the most current or highest quality evidence on which to base medical decisions.
An example of medically sound information for patients is a simple-to-use MyPlate tools and graphics which instructs patients on healthy eating and is available from the U.S. Department of Agriculture Center for Nutrition Policy and Promotion. The website of the American Heart Association is a reliable and patient-friendly place for patients to become educated on the topics of heart disease and stroke. The World Health Organization also has a library of online articles on topics from A (“Accidents, Radiation”) to Z (Zoonotic Influenza) for any medical super-sleuths you may encounter.
- Embrace visual aids. Whether to learn healthier eating habits or prepare for surgery, keep in mind that patients are navigating the internet looking for guidance. They may need a chart, map or model for how to get from where they are to where they need to be—and what they can do to expedite the journey. I particularly like the American Heart Association’s My Life Check infographic offering three starter steps to getting active.
In my next blog, I’ll focus on the importance of patient risk stratification tools in improving cardiac care outcomes.