Posts Tagged ‘informed patient’


Featured Guest Co-Bloggers:
Geri Lynn Baumblatt, M.A. and Nananda Col, M.D., M.P.H.

Excerpt from “The Value and Challenges of Shared Decision Making”, Dorland Review, February 2013

On the surface, Shared Decision Making (SDM) seems simple and straightforward.  A clinician involves the patient in making a decision about their health. The clinician conveys the necessary medical information to the patient, explains their treatment options, and helps the patient understand how their values, goals and preferences can guide them to find the best treatment. And together they come to a preferred treatment plan. Though widely endorsed, SDM is uncommon in clinical practice.1

SDM is a process that goes beyond “informed decision making,” which is sometimes erroneously used interchangeably with SDM. But shared decision making is not simply about whether the patient has been informed and received enough information about their condition and its treatment, but a process where the provider helps the patient understand the decision, its consequences, and then helps them apply their values and preferences in order to make a decision.2

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First, thanks to all the contributors for an amazing month of insightful articles on health literacy and shared decision making. If you missed any, here’s a recap.

Steven Kussin kicked things off by asking how patients can gain enough knowledge so they can be empowered to make informed, preference-driven decisions. But with more complex medical decisions do patients need even more advanced literacy?

Corey Siegel identified a black hole of information for both practitioners and patients: cost. Too many times people find out only after they choose a treatment what it will cost, what will be covered. How can we expect anyone to make long or short term decisions without this information?

Matthew Wynia and Andrew Jager asked what organizations can do to encourage and create an environment where shared decision making can occur. The Communication and Climate Assesment Toolkit identifies health literacy strategies like teach back and creating a space where patients feel safe and encouraged to ask questions.

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Featured Guest Blogger:  Gary Schwitzer

Gary Schwitzer

Gary Schwitzer

Every day for the past 6.5 years, I’ve worked with a team of great people to try to reach journalists and the public they serve to try to improve the public dialogue in the U.S. about health care.

HealthNewsReview.org has evaluated more than 1,800 stories, applying 10 criteria that we think address issues that consumers need addressed whenever they hear claims about health care interventions.

Even a casual observer should be able to see the connection with health literacy concerns in what we do. If the tsunami of stories that wash over the American public every day about claims for treatments, tests, products and procedures are not presented in a clear, understandable way with accuracy, balance and completeness, people will not be able to use that information.

But maybe the shared decision-making (SDM) link to what we do isn’t as obvious.

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Featured Guest Blogger: Nadia Ali, MB, MD, MPH

Nadia Ali, MB, MD, MPH

Nadia Ali, MB, MD, MPH

My husband woke me up at 2 AM on Monday morning for severe right shoulder pain, nausea and light-headedness. I drove him to the emergency room. Our initial encounter with the triage nurse was not very helpful. I tried to respond to her questions but she interrupted me saying the patient should answer her questions. He could hardly talk due to the pain and nausea. Finally she told us that he needs to be evaluated by the doctor and directed us to a door at the end of the hallway.

There were several doors that we saw and we were unsure about where were we suppose to go or who were we suppose to meet. There was no one to ask.

When we finally got into the emergency room, one of the nurses approached us and took us to one of the exam rooms. She told my husband to get into a gown and that she’d return in a few minutes. She left before I could tell her we had a very hard time getting his shirt on due to his shoulder pain and I needed some help. Anyway I helped him get into his gown.

The nurse returned after 15 minutes to check his vital signs and connected him to the monitor. I requested for something to relieve his pain and nausea. She said that he needs to be evaluated by the doctor before giving him any meds. Half an hour later, my husband was seen by the physician who took the history, conducted a physical exam and explained the plan of care.

My husband, who is educated and intelligent, got more confused with all the jargon used by the physician. I asked him why he didn’t ask any questions. He said he wasn’t sure it would be helpful in case the doctor repeated the same technical terms again. He also felt the doctor was possibly in a rush since he stood the whole time. Finally, around 4 AM, my husband got some pain and nausea medication. We left the ER around 6 AM with a script. Our next task was to find a pharmacy that would be open, since that information was not provided.

This was an eye-opening and powerful experience for me as a physician.

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Featured Guest Blogger: David Sobel, MD

David Sobel, MD

David Sobel, MD

My father died from cancer.  To be more specific, he died of malignant mesothelioma.  Now, all cancers are mean and ugly, but mesothelioma is slightly unique in that it is mean and ugly and fast.  From the time of diagnosis, 95% of patients will die within one year.  My father was textbook — he died 10 months after learning of the diagnosis.

I’m slow to admit that during those ten months between diagnosis and death, my father and I never specifically talked about his disease. This is even stranger when you consider the context. My father was a vascular surgeon which is to say that he was a methodical planner and meticulous about details. I was a surgeon as well, but also the co-founder of Emmi Solutions.  Emmi, as many of you know, makes patient engagement programs, and when I founded Emmi, it was to help empower patients; to provide them with the foundation and framework to engage in meaningful conversations about their own health decisions.  So, here I was all about patient engagement and my father was all about precision and care — and, yet, we never uttered the word “mesothelioma”.  Not once.

Is there room, then, in a forum on shared decision making and patient communication for a father and son who never acknowledged their diagnosis? I hope so for a couple of reasons.

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A Letter from the Editor: Geri Baumblatt
Geri Baumblatt

Geri Baumblatt, Editorial Director

 
In yesterday’s article, Dr. Jim Merlino asked, “How do we interact with patients? How do we manage the clinic or      bedside encounter? How do we organize information? How do we communicate?”
 
The day after reading those words, I observed a focus group where the discussion became pretty animated and one of participants said something like, “It’s not like when I was growing up. You just don’t know your doctor that well anymore, and they don’t know you! And they don’t have time to get to know you or explain things to you. Am I right!?” Three others in the focus group nodded in agreement. Happily, two didn’t – and explained they switched to doctors who do spend time with them. Still, 2 out of 6 – not ideal.
 
Then I read Dr. David Rubin’s amazing tribute to his mentor Dr. Kirsner. And it seemed to encompass so much of the bedside manner, connection and communication patients long for. So today, we share this tribute.
 
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Featured Guest Blogger:James I. Merlino, MD

James Merlino, MD

James Merlino, MD

Every day, physicians and other healthcare professionals around the globe spend hours and hours learning how to keep up with the latest and best medical information. Being a life-long learner is part of the deal that comes with the sacred trust and commitment necessary to care for patients. When we sign up for this profession, we accept that part of the responsibility requires us to ensure that we know the most relevant and up-to-date medical information.

What is often ignored in this learning process is paying attention to developing the tools that let us improve the actual art of the “practice” of medicine. How do we interact with patients? How do we manage the clinic or bedside encounter? How do we organize information? How do we communicate? These are very important tools, but often they are not part of the normal teaching program for physicians in training, and certainly not regularly covered in continuing medical education for physicians in practice. Any discussion of these tools is often relegated to the generic heap of the physician’s “bedside manner.” And, the proverbial “bedside manner” is often learned by observation of mentors and teachers while physicians train – sometimes not the best role models. When new doctors set out to begin practices on their own, they are often forced to rapidly adapt based on what they assume to be observed best practices.

But these tools are much more important. They are not only an essential and necessary component of every encounter with patients at every stage of the patient journey; they also mine the patient data that is necessary for medical decision-making, enabling physicians and other providers to effectively do their jobs. Just like learning how to apply medical knowledge, these tactics can be learned, monitored, refined and improved. And, just as surgeons should think about how to make operations more efficient and effective, healthcare providers should spend time thinking about how to make their interactions with patients more productive and meaningful for both the provider and patient.

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