It’s extreme. It has the power to improve safety and quality of care, enhance patient outcomes, reduce cost and significantly enhance patient and provider satisfaction almost overnight. It is supported by the evidence, costs much less than a $44,000 physician-office EMR system and is easy for most if not all to use. It even has a high-tech sounding name complete with a nifty acronym. What is this disruptive innovation? I call it Bi-directional, Concordant Discourse or BCD.
Simply put, BCD is a face-to-face, conversation between physicians and patients about topics that are relevant to both parties.
The operative term here is “relevant.” Here’s an example. Let’s say that I am a physically active, relative healthy person with an aversion to taking medications. Assume that my “aversion” goes back to a bad experience I had with taking a new medication and a resulting belief that medication
s are over-prescribed and often ineffective. Now let’s assume that at my next visit, my doctor puts me on a statin to lower my cholesterol. My doctor spends about 1 minute explaining his rationale for why I need to take the medication while writing out a prescription. I take the prescription and then drive home without ever filling the prescription.
Why I do not fill my prescription
I don’t fill the prescription because, in my opinion, my doctor’s advice is “irrelevant.” It is goes against everything I believe, feel and know. I guess I also don’t entirely trust that my doctor is “on top of things” given his busy routine. Technically I am sure it is good care. The problem is that at this stage of my treatment, I do not feel it is the right care for me. Had my doctor asked for my opinion about taking medications he would have known that I had a previous bad experience. Had my doctor heard and remembered that I workout and am into my health he might have anticipated that I might prefer to work on lifestyle issues before going on medication. Maybe then he could frame or tailor his treatment recommendation in a way that I could relate to. In this hypothetical example, my doctor never connected all the dots, mostly because he never _______ you fill in the blank (asked, heard, remembered, anticipated, framed/tailored recommendations)…and I never forced the issue by telling him.
Bi-directional, Concordant Discourse or BCD is disruptive on so many levels
First of all BCD can be relatively simple for patients and physicians to use. It starts with an open-ended question from the physician like “what can I do for you today?” The patient talks for about 30 seconds while the physician listens, shows an appropriate amount of empathy, and the next thing you know a conversation is born.
Second, conversations are convenient…more convenient that biomedical physician monologues. Heck the physician doesn’t need to worry about doing all the talking if they get the patient involved. Conversations are also a great way for both physician and patient to learn important things from one another.
Third, relevant, highly informative conversations between physician and patients has been shown in the research literature to build patient trust, increase patient engagement, increase patient adherence, enhance patient satisfaction, improve outcomes and reduce costs.
Eventually I expect that physicians, hospitals, payers and regulators will discover what patients already know. That a simple, focused conversation between the patient and their physician can do more to increase patient safety, quality of care, satisfaction and adherence, than Electronic Medical Records, Smart Phone Apps, text messaging will ever be able to do. It’s time we all begin to connect the dots.
*Bi-directional, Concordant Discourse – you heard it first on Mind the Gap!
Sources:
Heritage, J. et al, Reducing Patients’ Unmet Concerns in Primary Care: the Difference One Word Can Make. Journal of General Internal Medicine. 2007.
Barrier, P. et al, Two Words to Improve Physician-Patient Communication: What Else? Mayo Clinical Proceedings. February 2003.
I couldn’t agree with you more. That is one of the premises behind the system I developed to help people take control of their care and prevent medical mistakes.
For a patient to be able to enter into that discussion in a meaningful way he/she must first be actively involved in their care, have their own information at their fingertips and know how to use it. If they don’t their ability to engage is greatlydiminished.
If a doctor has a closed mind and/or doesn’t listen to the patient and answer questions, will this format really change the doctor’s behavior?
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Jim,
Research shows that physicians communicate better with patients they believe are engaged in the visit and their own care as evidenced by asking questions. One solution to the communication barriers you cite is to teach patents the value of prompting their physicians with questions and requests much like DTC pharma commercials do.