Placing The Patient At Center Of The Doctor-Patient Relationship

Dr Neil H Baum

Neil H. Baum, MD

Today the patient is far different than the patient of a few decades ago.

Patients can find healthcare information just as easily as a physician and many are taking a greater role in their healthcare and want to be involved in the decision making and work with the doctor as a team with the doctor being the captain of the healthcare ship.

This new attitude has been referred to as patient-centered healthcare. Patient-centered care occurs when the processes and culture (attitude and behaviors) of the caregivers address the wants and needs of the patient.

Patient-centered primary care is beginning to take root.

The Institute of Medicine (IOM) includes patient-centered care as one of six domains of quality. Yet the IOM also notes that a chasm exists between the kind of care that patients receive and the kind of care they should have, and calls for fundamental change in the system of care. It further argues that these changes would both be better for patients and make the provision of care more satisfying for clinicians.

Here are a few examples of how you can put patients into the center of the equation of the doctor-patient relationship.

How would you like to hear the results of your test, email, phone call, automated lab results telephone contact, or written report? The days of "no news from the doctor is good news" is no longer applicable in the age of putting the patient at the center of care. Today every patient should receive a communication regarding every test result, even if the results are normal. It is recommended that you put in place a policy that if patients don't hear from the doctor's practice about the test results, the patient should contact the office. It is likely that patients will have a favorite method of being informed and you won't know unless you ask.

Which arm would you like to have your injection? Right-handed patients may want the injection in their left arm. Patients who participate in sports may want the injection in the buttocks and not in either arm. Patients appreciate having a choice where they want to receive their injections and what arm they would like to have their blood drawn.

Would you like to see the x-rays? Now with the use of picture archiving and communication system (PACS), it is very easy to show the radiographic results on your computer. Many patients are now very interested in seeing the pathology of the findings of their radiographic studies.

Can I show you a diagram of your problem and what we will do to treat the problem? There are a number of programs available for the computer that feature nice graphics that allow you to illustrate and discuss the details of the findings and the plan of action. I use a free program, Draw MD (www.drawmd.com) on my iPad to demonstrate procedures and the pertinent anatomy.

Use the patient's name. The most important word in the human language to each and every one of us, is the sound of our own name. We all like to be called by our names and the receptionist, the nurse, and the doctor need to refer to the patient by their name at least twice during the office visit.

Use social progress notes. Patients like to be thought of as more than a condition, illness, or diseased organ system. It is a nice to acknowledge patient's accomplishments, hobbies, or life events such as birthdays or anniversaries. I call these social progress notes, and these can be placed in the patient's chart or in the EMR; and the staff and doctor can refer to these personal topics before launching into the patient's medical problem.

Would you like this prescription electronically sent to the pharmacy or would you like to have the paper prescription? Not everyone wants to use e-prescribing and patients will usually opt for the new technology but appreciate the choice.

There are four options for treating your medical condition. Let me describe the possible options and then you can select the one that is best for you and your situation. This patient centered approach applies to treating many other medical conditions when one option does not apply to everyone.

Would you like some educational material on your condition? There are so many ways to educate patients today on their medical problems. Not everyone has a DVD player and giving the patient a DVD may not be the only method of providing educational material.

Can I provide you with a list of websites that have credible information on your condition? Healthcare is the second most commonly searched topic on the Internet and patients will often stumble on non-credible websites. You can do your patients a service by providing them with a list of websites that have accurate medical information.

Would you like a generic prescription, which has a few more side effects, or would you like a brand name medication that has fewer side effects but is more expensive? Not everyone can afford the newer brand name products. It is such a nice gesture to offer the patients a choice.

Would you like to complete the health questionnaire and several forms for your records in the office or in your home and bring it with you to the office? If you have the receptionist recommend that the patient visit the website and complete the health questionnaire at home before they come to the office the visit will be expedited. If the patient doesn't have access to the Internet, they can fill out the necessary forms in the office but that they need to arrive 15-20 minutes earlier than their appointment time to complete the necessary paper work. This will improve your workflow and improve the efficiency of your practice.

Do you have any other questions that you would like for me to answer regarding your visit?This question puts the patient at the center of their visit to your office and should be asked to nearly every patient before the encounter comes to a conclusion.

Bottom Line: Patients want and need to take a greater role in their medical care. Using a few techniques like those listed above is a cost-effective method of developing a patient-centered medical practice.

UPDATE: Challenged by the (loosely translated) comment of "who's got the time for that?" Dr. Baum adds: "I use all of the techniques described in the article and can see 25 to 30 patients a day including three to six new patients a day. I have a staff of eight and they make a large contribution to the patient-centered philosophy."