Grand Rounds Vol. 7, #30: Patient-Centered Care

By the rude bridge that arched the flood,

Their flag to April’s breeze unfurled,

Here once the embattled farmers stood

And fired the shot heard round the world.

Concord Hymn, first stanza

Ralph Waldo Emerson, 1836

Welcome to Better Health’s Grand Rounds, Volume 7, Number 30.  This week’s theme borrows from Patriot’s Day which commemorates the anniversary of the Battles of Lexington and Concord, Massachusetts, the first battles of the American Revolutionary War, on April, 19, 1775.  

Massachusetts has given birth to numerous revolutionary ideas since our country’s founding, including its passage of landmark health reform legislation five years ago.
While patient-centered care did not originate in Massachusetts, the Boston-based Schwartz Center for Compassionate Healthcare has been one of its most vocal supporters.  The Schwartz Center has long advocated for making patients the focus of care and an integral part of the clinical decision making process.  This week Grand Rounds focuses on revolutionary ideas in patient-centered healthcare. (Our photos feature scenes from the annual reenactments of these battles, which are staged at the original sites in Lexington and Concord, Massachusetts.)

Starting at the top

Paul Levy, former hospital CEO and advocate for patient-centered care, leads things off with a post highlighting the research of Dr. Linda Pololi from the Women’s Studies Research Center at Brandeis University, at his blog, Not Running A Hospital.   Dr. Pololi has studied how medical education often fails to provide physicians with the skills they need to form effective relationships with colleagues and patients.

At Navigating the Health Care System, Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality (AHRQ), describes how health information technology promotes patient-centered care by enhancing the doctor-patient relationship.

Jesse Gruman of the Health Affairs Blog learned first hand that serious illness can cloud a patient’s judgment and impair his or her ability to think through important issues associated with medical care.  For this reason Jesse suggests the use of a well-defined framework to guide patients and their doctors through the decision making process. 

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has created incentives to make the patient experience a priority for all hospitals.   Dr. John Schumann at GlassHospital proposes a simple way for hospitals and physicians to sort through the process of patient satisfaction scoring. 

And now for something completely different: at H3P0, the blog of the Washington Health Foundation, Fisher Qua suggests that the concept of patient-centered care does not go far enough in transforming healthcare.  He describes how the Washington Health Foundation has adapted the concept of person-centered design to create the Health HoME, a concept focused on empowering patients by making the healthcare system more understandable.

Information is your ally

Have you got six seconds to spare?  Stephen Wilkins at Mind the Gap discusses how techniques like agenda setting and active listening can improve the quality of information gathered from patients and enhance doctor-patient relationships with a minimal investment of time.  

Amy Berman, RN, a senior program officer at the John A. Hartford Foundation, was recently diagnosed with Stage IV breast cancer.  At Health Agenda, the blog of the John A. Hartford Foundation, Amy courageously discusses her decision to forego aggressive medical treatment in favor of a better quality of life.  Amy hopes her story will encourage patients to become better informed so they can make decisions that are consistent with their values, not the values of the medical system.

At the Value of Openness, the blog for PatientsLikeMe, a community where patients with serious illness connect and share information, co-founder Ben Heywood explains how information sharing can empower patients and enhance their connection to the traditional medical system.  

All information is not created equal:  Dr. Val Jones, the founder and CEO of Better Health warns that the mainstream media may not provide patients with medical information that is in their best interest or appropriate.   Her post is a reminder that a patient's trusted advisor should be his or her personal physician or other clinician, not a media personality. 

Views from the front

We include several posts from physicians who are at the frontlines in the battle to make patient-centered care a reality:

• Dr. Toni Brayer at Everything Health illustrates the importance of communication and understanding a patient's life situation following a hospital stay.

• The tables are turned as Dr. Ramona Bates, Suture for a Living, shares lessons about improving communication with patients after her frustrating experience as the family member of a patient.

• Being able to apologize when something goes wrong is essential to maintaining credible relationships with patients. Dr. Will Meek, a psychologist and therapist from Vancouver, provides valuable guidance on the art of apologizing.

• Patient-centered care is a global issue.  At BJCHealth, Dr. Irwin Lim, a rheumatologist from Australia, outlines how his practice is using multidisciplinary teams to treat patients holistically and improve outcomes.

Other thought-provoking submissions

These submissions fell outside our theme of patient-centered care but are worth your consideration:

Golf and evidenced-based medicine?  At Academic OB/GYN, Dr. Nicholas Fogelson considers whether the master club fitter at his golf course can serve as an example of how experience combined with scientific evidence can achieve optimal outcomes--both on the course and in the exam room.

The deadline for filing your taxes may have passed, but the team at Colorado Heath Insurance Insider, reminds us there’s another important deadline around the corner.  Employers only have until May 1 to apply for the popular Early Retiree Reinsurance Program offered by the U.S. Department of Health and Human Services.  This important program fills the health insurance gap that’s created when employees retire before qualifying for Medicare.  

And speaking of Medicare, the Happy Hospitalist - with his characteristic humor and wit - ponders alternatives to a new Medicare rule, taking effect in 2013, which would penalize hospitals for higher readmission rates.

Accountable care organizations (ACOs) are currently being promoted as a way to revolutionize the delivery and financing of healthcare.  ACPInternist looks at some ACO models that have been particularly successful.

Across the pond: Henry Stern at InsureBlog questions the wisdom of Britain’s National Health Service as it attempts to limit the use of robotic surgery.  

Concerns about the risks associated with cell phone use are very real among patients despite inconclusive scientific evidence about their impact on health.  In Examining Room of Dr. Charles, the good doctor advises physicians to remain open to their patients’ concerns as scientific knowledge continues to evolve.

And on the topic of scientific research, Dr. Paul Auerbach contemplates the conundrum of pathogen exposure and its impact on childhood health at Healthline.

A call to arms (and bloggers)

Selena Inouye, a cancer survivor and fellow blogger, needs your help.  Please consider visiting her blog, Oh My Aches and Pains, on Friday April 22 and leaving a comment on her post about her experience as a young adult cancer patient.  Selena is trying to break a record for the "Most Comments Received on a Cancer-Related Blog Post in 24 Hours.”  The event, sponsored by the Livestrong Young Adult Alliance, is designed to raise awareness about issues facing young adults diagnosed with cancer.   

We hope you enjoyed this edition of Grand Rounds.  Thanks to all who contributed.  Next week’s host will be Dispatch From Second Base.