Posts Tagged ‘Physician’

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Geri Lynn Baumblatt

The Informed Medical Decisions Foundation has branded the month of March “Shared Decision Making Month,” and, in an effort to more greatly promote shared decision making (SDM), 5 RAND researchers conducted interviews to determine what factors currently barricade SDM implementation.

The researchers questioned 8 different primary care organizations that are participating in a three-year demonstration, and found a variety of factors contribute to implementation issues including physician workload and training as well as insufficient information systems.

Physicians within the demonstration, even when reminded, still only extended shared decision making aids to 10-30% of their patients, and many physicians were unaware that their current tactics didn’t qualify as “shared decision making.”

Additionally, even if physician-barriers to SDM were corrected, information systems largely lack the ability to track whether patients actually use the aids they are given. It isn’t enough to simply present patients with shared decision making materials; they need to be persuaded to actively participate in their health decisions.

Therefore, researchers suggest ways providers can attempt to combat these barriers. For example, by using automated triggers – pre-determined situations or conditions in which patients “automatically” receive a shared decision making aid. They also suggest properly training physicians to promote shared decision making and to get other clinical staff engaged in the process as well.

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Welcome to Health Literacy Month. This year, we’ll look through the lens of health literacy to  think about shared decision making. On the face of it, the shared decision making equation seems simple:

A patient learns about their options + Physicians and healthcare providers learn what the patient values = Together they figure out the best treatment options

But there are health literacy issues on all sides.

There are numeracy challenges not just for patients, but practitioners as well.  Patients desperately want to understand the risks and common outcomes of each treatment option. But physicians and researchers often need to unpack the numbers across multiple studies. And sometimes the numbers simply don’t exist — at least not in the straightforward way people want or need them. Other times, a doctor’s own experience with specific patients can influence how they think about or explain the numbers.  And patients often see themselves as the exception to the numbers. And who hasn’t had the thought, if one in 15 die from this, I could be “the one”?

For example, if a 15-minute program or video goes over three options for prostate cancer: watchful waiting, radiation, and prostatectomy, it’s natural to spend less time explaining watchful waiting. There’s just not that much to go over — no big procedure to explain, not a lot of possible side effects, etc.  But the time needed to explain what prostate surgery is, the risks and recovery usually just takes longer.

However, in focus groups we found that if we don’t spend almost the same amount of time talking about watchful waiting, even though there was less to explain, men felt it wasn’t a “real option”, or it must not be a good option – or even voiced concern  the program may be biased against it. So in this case, time spent truly seemed to affect patient perceptions and understanding of their treatment options.

There are also common biases and preconceptions people have about treatments.  If you know that many women believe the most aggressive treatment will give them the best chance of survival (say a mastectomy vs. lumpectomy), how do you account for that pre-existing bias in the shared decision making process?

So while shared decision making is not new (and really sounds a lot like a good practitioner having a meaningful conversation with a patient), the art and science of shared decision making still faces a steep learning curve. And there may not be one best way for the variety of decisions that exist.

Throughout the month you’ll hear a variety of insights and perspectives. In the spirit of shared decision making, please participate.  Your questions, real experiences, and opinions can only move us further along the path of understanding what works.

Geri Baumblatt

Geri Baumblatt, Editorial Director

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KevinMD—We caught a great essay by Steve Wilkins, MPH on KevinMD this week. Wilkins asserts that if CMS bundled payments inspire hospitals change in the name of quality and efficiency, then the primary task will be to find new ways to engage patients.  But here, he says, is the rub. For healthcare providers, patient engagement “has been a tough nut to crack.”

The answer is better communication. Wilkins cites a handful of studies highlighting the impact of physician-patient communication, and more tellingly, the cost of frequent breakdowns and miscommunication. Here’s two quick excerpts:

“In the study, 55% of patients diagnosed with heart failure did not recognize (nor agree with their doctor) that they had heart failure.  Even more disconcerting was the finding that “only 15% of those with hypertension agreed with their doctor’s diagnosis.”

It’s worse for African-Americans who experience heart failure at 20 times higher than Caucasian counterparts.

“Numerous studies have revealed that when treating black patients, as opposed to white patients, physicians tend to “provide less health information, are more physician-directed (versus patient-centered), spend less time building a rapport with patients, and are more verbally dominant.“  In other words, the patients that are in greatest need for patient-centered communications, and the benefits it provides, are presently the least likely to receive it.”

In short, Wilkins argues, ACOs are in trouble if the current state of physician-patient communication doesn’t improve dramatically.

Our Take: Yes. The success of new models of care hinges on healthcare organizations’ ability to effectively engage patients to take more active roles in their care. Doctors and hospitals cannot be everywhere at every time for every patient forever. Patients have to better manage their own conditions. What’s more. This is what they want. It’s what we (as we are all patients) want. But we need the information, guidance and tools to do so. An extension of the status quo simply will not be enough in a bundled-payment, pay-for-outcomes world. Let’s get moving on implementing new ways to transform and extend physician-patient communication.

More information from KevinMD

 

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KevinMD – In this article, Dominic A. Carone discusses ways doctors can lose patients from a non-physician perspective.  Carone, a practicing Neuropsychologist, observes and speaks with patients about their medical and care provider history.  Over time, he has noticed trends in stories from patients who have changed care providers because they were unsatisfied.  Here’s his top 10: (more…)

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Doctor's Office, Waiting Room

This picture was taken some time between 1989 and 2011.

Health Populi – A recent study finds patients are more satisfied with their care if they are given self-service options online. Many patients expressed they would consider leaving their current physician’s practice if online tools were not made available. Online capabilities that give patients the opportunity to complete paperwork prior to their visit were also widely praised, especially since over 50 percent of doctors say patients complain about time spent in the waiting room.

Our Take: People hate waiting for stuff. And in today’s world, there’s rarely a need to do so. We got to our doctor’s office by having our car literally talk to us, showing us how to get to our destination, like Kit from “Knight Rider.”  Before we left, we sat on the sofa fast-forwarding past commercials with one hand while cashing a check by taking a picture of it with our smart phone in the other. Everywhere in our lives, things are getting faster, simpler, more tailored to our preferences and past experiences. But at the doctor’s office, it’s like visiting 1995—a place where people still read magazines and it takes forever to do anything.

It’s no wonder that there is popular acclaim for any small innovation that bring the health experience closer to any other transaction common to this decade.

For more information visit Health Populi

Image by The Consumerist via Flickr

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Stethoscope

Fierce Healthcare – A report released by PriceWaterhouseCoopers’ Health Research Institute gave some foresight into the evolving relationship between hospitals and physicians with some surprising results. Here’s a snapshot of the survey:

A full 45 percent of physicians say they would want more money if they went to work for a hospital–an average of 2.4 percent. But a total of 55 percent said they either wouldn’t expect a pay hike (38 percent), or that they’d take a pay cut (17 percent)… Nearly all of the study’s respondents (between 93 percent and 97 percent) say physicians will need to serve as hospital executives, on boards of directors and in other leadership positions.

Physicians surveyed also indicated they would be willing to accept national quality metrics in exchange for a guaranteed salary.
Our Take: It is not surprising that all parties involved in healthcare reform are willing to accept change if they receive more money, more stability or more power. It is noteworthy, though, that doctors surveyed here were mostly willing to give up money (or at least not ask for more) in order to move forward with ACOs.

The news on this issue is often dominated by parties unhappy with the status quo, unenthused about reform and unwilling to compromise. And yet, this survey depicts physicians as open to change. No, they are not willing to put their entire earnings at risk in pay-for-performance models that are still in development and incomplete. But they are willing to put their feet in the water. Actually, they are willing to put more than feet. Most doctors surveyed would put pay at risk if only half of their salary were guaranteed. This is progress.

More information from Fierce Health

Image by velfaerdsteknologi via Flickr

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Courtroom

KevinMD- A recent essay by Dr. Aaron Carroll, the noted physician, researcher, economist and blogger explores the root causes of malpractice claims. Carroll quotes study after study tying lawsuits to patient satisfaction in particular and the physician-patient relationship overall. The answer to reducing malpractice claims, Carroll explains, is simply being a better person (ie being kind to patients, listening to patients, explaining care to patients, and admitting mistakes when they happen). Why then, he asks, don’t physicians (or at least the most frequently sued physicians) do this? His answer:

My answer was that I have built a career on docs not doing what they should.  That’s flippant, but it really is hard – very hard, in fact – to change what doctors do.  There are guidelines and papers and continuing medical education and still it’s glacial work.

But you would hope that this message – that being better people, even more than being better doctors, would reduce malpractice suits – would be an easy one to implement.

Our Take: Simple things are rarely easy. Being a good listener, a good communicator, and a person humble enough to admit mistakes in the face of difficult consequences—all of these are lifelong challenges. We at Engaging the Patient believe doctors need the tools and support around them to fill gaps in communication when breakdowns inevitably occur. And this blog is dedicated to highlighting solutions and approaches to this issue.

More information from KevinMD

Image by srqpix via Flickr

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