Five Ways to Tell If Your Physician Is Patient Centered

Hint- Being Designated As A Patient Centered Medical Home Is Not One

We hear a lot about patient centered care these days.  In particular, a growing number of physicians across the country are now referring to their practices as a Patient Centered Medical Home.

But how can you tell if your physician’s practice really is patient centered no matter what he or she may call them self?   More importantly, why should you care?

What is patient center care you ask?  It’s is quality care delivered in a manner where you feel that your provider:

• Knows who you are personally as well as clinically
• Understands, respects and honors (where practicable) your previous health experiences, beliefs and preferences
• Facilitates and supports your health choices and behavior barring a serious conflict of beliefs or principles

Since each of us possess a different set of experiences, beliefs and preferences, patient centered care by definition is tailored to individual patients.   For example, some patients like their doctor to take charge and make the important decisions.   Other patients may want to be the one in charge, while others still may prefer a more collaborative style.  Ideally a patient centered physician knows where the patient is coming from and does his or her best to accommodate the patient.    Why?  Because patient center care, where the patients feels understood, listened to and respected, results in increased patient compliance, improved health status and better outcomes.

Five Ways to Tell If Your Physician Is Patient Centered Your doctor asks you up front “what brings you in to see me today” and then let’s you answer the question without interruption.   In other words your doctor is a good listener. Your doctor asks you for your thoughts regarding the cause of a health concern, as well as any thoughts you may have for how to deal with a particular concern? You feel like you can talk to your doctor about your interest in seeing a chiropractor or acupuncturist without fear of ridicule. Your doctor does not “default” to prescribing a medication knowing full well you don’t like taking medication. Your doctor asks you about other aspects of your life (family, work, social) that may serve as context for  making the best treatment recommendations.

It may be helpful to understand what patient centered care is not, at least for some people.   Remember it can be different for each patient.

Patient centered is not necessarily about being designated as a Medical Home, having electronic medical records, offering e-mail visits, group visits, or collaborative care, although it may be for some patients.  Nor is all about collaborative care planning, joint decision making or team care.   Again, different strokes for different folks.

Why should you pay attention to which physicians are patient centered and who are not?

There are many reasons, but first and foremost, you are more likely to get  appropriate (e.g., better) care, tailored to your beliefs and preferences.   Odds are you will have a much more satisfactory health experience and will be more likely to follow your doctor’s recommendations.  After all you helped come up with them.

Warning!

Be very suspicious when you come across providers or hospitals calling themselves “patient centered.”  If you want to have some fun, ask them what they mean by patient centered.   If they say it is because “we put the patient first” you know they haven’t a clue and are just using it as a marketing ploy.

Do yourself a favor and run for your life!!

Accountable Care and Effective Physician-Patient Communications – You Can’t Have One Without the Other

Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act.   The concept behind Accountable Care Organizations is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia), we can expect to see an improvement in quality and value.

In principal accountable care makes a lot of sense.   Practically speaking however, doctors and hospitals must address a huge challenge before they can expect benefit financially.

Before doctors can be held accountable for the care they deliver, they first must be held accountable for the quality of their communication with patients.

Take hospital re-admissions which are a big cost-driver today.   According to a recent study in the New England Journal of Medicine, 20% of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34% percent within 90 days.

The Joint Commission and others believe rightly believe that inadequate communication between physicians, as well as between physicians and patients, is a major contributing factor.

Here’s an example.   In a small study of 47 patients surveyed at time of hospital discharge (Commercial and Medicare), 72.1% of patients were unable to list all their discharge medications.  86% were unable to describe the common side effect(s) of all their medications, and 58.1% did not know the diagnoses that put them in the hospital in the first place.  These trends are consistent with the findings from a number of similar studies, including studies of discharged ER patients.

Physician-patient communications shortcomings abound in the doctor’s office as well.    Approximately 20–50% of patients do not take medications as prescribed.  It’s not necessarily because patients are non-compliant.  Patients don’t take medications out of fear of drug interactions, perceived lack of effectiveness, adverse effects, misunderstanding regarding necessity, or concerns about costs.

Patients who report better general communication with their doctor, i.e.,  better instructions on how to take a medication, and who receive more medication information, are more likely to take medications as prescribed.

The success of new financing and delivery models like Accountable Care Organizations and Medical Homes depends heavily upon significant address the quality of the current state of physician-patient communications. I wonder when today’s physician and hospital leaders will get a clue.

Sources:

Makaryus, A., et al. Patients’ Understanding of Their Treatment Plans and Diagnosis at Discharge.  Mayo Clinic Preceedings, 2005.

Coleman, E., Rehospitalizations among Patients in the Medicare Fee-for-Service Program. New England Journal of Medicine. 2009.

Kripalani, S., et al. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians.  JAMA 2008.

What Do Doctors Know About The People In Their Waiting Room? – The Scourge of Unemployment

Anyone has ever been down-sized or otherwise lost a job knows the feelings.   Personal loss (social, financial and routine),  self doubt, and in some cases fear of what the future will bring.   Unemployment and its cousin under employment are not subjects that a lot of people are comfortable bringing up in polite conversation…even with their doctor.

Given today’s tough economic environment, chances are that 15% to 20% of the people sitting in most doctors’ waiting rooms are out of work.  Do you know who they are?

You should.

Losing a job is a highly stressful event.  For most employed adults, work is a central part of one’s life and identity and a major source of income.  While job loss affects people differently, research suggests that loss of a job affects how many people feel – emotionally and physically.  Job loss, as well as job insecurity, has been linked to increased mental distress (depression) and physiologic responses such as a weakening of the immune system, increase inflammatory response which is associated with cardiovascular disease as well as an increase in blood pressure.  Depression is also correlated with more physician visits, medical tests, RX medications, hospitalizations and decreased adherence among patients.

As I pointed out in an earlier post:

It costs twice as much to treat a patient with depression ($4,780) as it does to treat a patient without depression ($2,794).

The solution?

Ask your patients what’s going on in their life, including current or potential job loss and problems at home.  Understanding the context of the patient’s life will allow you to provide true patient centered care to patients that desperately need and want your help.

Addendum:  For more information check out the following NYT article:

When Unemployed Means Unhealthy Too

Source:

Cohen, F., et al. Immune Function Declines With Unemployment and Recovers After Stressor Termination. Psychosomatic Medicine 69:225–234 (2007).

Depression Among High Utilizers of Medical Care.  Pearson et al.  Journal of General Internal Medicine. 1999: 14:461-468.