Thursday, April 5, 2012

Guest Commentary: A Different Perspective on Patient-Centeredness

Stephen Wilkins, MPH

Running concurrently with the recent Population Health & Care Coordination Colloquium in Philadelphia was the Fourth National Medical Home Summit, at which I was privileged to speak. Patrick Monaghan of the Jefferson School of Population Health noted in his recent post that “patient-centered care appears to finally be at the heart of the way healthcare is delivered in this country. And if it’s not, it’s certainly on the way.”

Now you would think that at a conference on the Medical Home, the care delivery model for value-based care and all things patient-centered, the topic of patient-centered care would be a topic of discussion….but you would be wrong. In fact, I was one of the few speakers that substantively addressed the challenges associated with the concept of “patient-centeredness.”

To be sure, patient-centeredness has arrived at the health care policy level. Health care markets too have discovered the benefits of being patient-centered. Like patient empowerment and patient engagement, the term patient-centered is ubiquitous in both the health care and popular media. The one place you apparently do not find things patient-centered discussed is at conferences dealing with Patient-Centered Medical Homes.

Of course there were presentations about EMRs, embedded care coordinators, population health management, and patient advisory committees. Yes, these are all prerequisites for PCMH certification– but there is nothing inherently patient-centered about any of these things. What was missing at the Summit, and from the current discourse about Medical Homes, is any meaningful discussion of what the providers of care (or the sponsors of PCMH pilots) are doing to engender a patient-centered orientation into the way they communicate with and care for patients.

Perhaps the biggest disconnect between the reality and the promise of patient-centeredness is found in the way physicians communicate with patients. As defined in Crossing the Quality Chasm, patient-centered care begins with the provider understanding the patient’s perspective, e.g., their fears, concerns, expectations, and previous health experiences.

However, many primary care physicians, including those practicing in Medical Homes, still communicate with patients using the same physician-directed style they were taught in medical school. Like the medical interview itself, a physician-directed style of patient communication does not allow much time for the patient’s story or for that matter identifying all the reasons why the patient wants to consult with their doctor. As a result, the patient is the subject of the medical exam…not an active participant.

Patient-centered communication has been the subject of research going back 30 years, including detailed descriptions of effective patient-centered communication techniques. The use of patient-centered communication is directly correlated with improved outcomes, quality, and patient satisfaction. When employed consistently over time, it probably even saves time. Yet the use of patient-centered communication in the Medical Home is not a priority for providers or accreditation agencies.

To bridge this disconnect and eventually realize the promise of patient-centered care, professionals in both the Medical Home and Population Health arenas need to focus more on the true meaning of patient-centeredness and how to integrate the philosophy of patient-centered care and the commensurate communications skills into everything we do.

Stephen Wilkins is the CEO/Founder of Smart Health Messaging, a communication firm committed to improving the quality of physician-patient communication. He is also the author Mind the Gap, a blog dedicated to the same subject. Mr. Wilkins was a contributor to Disease Management and Wellness in the Post-Reform Era, (Chapter 3 - Disease Management & the Medical Home) published in 2011.

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