Last week I wrote about the medical home and who it is built around, arguing it is not the primary care office but the patient and their home. There is no doubt the primary care office is a critical component of the patient’s support system, while at the same time true patient centeredness requires defining everything from the eyes and heart of the person seeking health improvement or prevention services.
So how do health systems or providers improve “patient centeredness”? Extensive literature has been written on the topic; some of it is unsatisfying and so soft and squishy it is difficult to get one’s arms around. There are several things medical groups and health systems can encourage that will improve the relationship with the patient.
Michael Balint used the term “patient centered” in 1969. His original paper points out the need to move from “illness-oriented medicine” to “patient-centered medicine.” Illness-oriented medicine is “identifying a localizable fault, diagnosing it as an illness, and then treat it.”
Patient-centered medicine considers the "whole person" and the fact that each person is a unique human being, and that whatever diagnosis or treatment is being considered has to be considered in light of the unique human being. How we listen to an individual and the language we use to talk to an individual is based upon who that person is and understanding their needs. This is why communication is the core of establishing the kind of trust that this relationship requires. As Maureen Bisognano, CEO of the Institute for Healthcare Improvement says, we need to move from asking “what’s the matter?” to “what matters to you?”
Balint went on to establish a practice of providers talking to each other, which is called “Balint groups.” The groups are intended to help providers understand and improve patient relationships, especially ones that the provider struggles with. Some residency training programs now include the regular practice of “Balint groups.”
An effective practice to be sure providers are connecting with the core values of the patient is called “motivational interviewing.” This evidence based method of interviewing patients is based on collaboration, which evokes the patient’s own thoughts and ideas (particularly about change), and emphasizes the autonomy of the individual.
Another practice is that of including patients in the strategic planning and operations of medical groups and hospitals. In Massachusetts, all hospitals have Patient Family Advisory Councils, a process that brings together patients, family members, and hospital staff in ongoing efforts to enhance the patient and family care experience. But we can do more. At Cincinnati Children’s Hospital, parents sit on the ICU management team. An orthopedic surgeon who has been able to achieve remarkable results with patient experience, clinical outcomes, and cost shows how he uses patients in his care planning in this video.
It is reassuring that rather than just exhorting ourselves to listen better, there are evidence-based best practices to help us strengthen the relationship with those who trust us in their most vulnerable moments.