How to Make It Work
Pector, Elizabeth A., Medical Economics
Consumer Reports recently surveyed more than 600 primary care doctors and 49,000 patients to learn what makes the patient- doctor relationship tick. Consumer Reports' wide-ranging findings cluster into several categories of wisdom:
Time is a major factor in the primary care relationship. Patients don't like long waits for doctors, and doctors are annoyed when patients bring up multiple concerns in time allotted for one. When time is counted in years, the primary physician's complete record of a patient's health limits redundant testing and promotes positive change.
To organize face-to-face time with patients, doctors can use several strategies. My nurse helps to plan chronic illness or physical appointments by generating test orders so data are available at the visit. She enters chart reminders for vaccines and screenings. We encourage patients to bring a list of concerns, medications, and blood pressure and glucose logs. At well visits, they complete a written health history update. My paper-based tools are posted on my Web site, synspectrum.com. Some of my colleagues use electronic patient self-assessments.
Technology, the second factor, is receiving unprecedented attention with primary care medical home initiatives and meaningful use. The Consumer Reports survey found that 37% of primary care doctors are using electronic health records (EHRs), a jump of 13% compared with 4 years ago. While 61% of patients search online about their health conditions, fully half of doctors believe their patients' Web research has little to no value. However, I'm finding that most patients use reliable online sources. Still, they can be overwhelmed, like my two recent breast cancer patients who struggled to understand oncology stats on surgery, chemotherapy, radiation, and genetic testing before they had their final pathology results. In response to this trend, our hospital hired a "breast cancer navigator" to help patients understand which information mined from a mountain of data actually applies to them. I predict the typical primary care physician's duties will develop into a similar health-navigator role in the years ahead.
Some of my favorite Web sites include those of the Centers for Disease Control and Prevention, the Food and Drug Administration, Medline Plus, and the National Cancer Institute. I also download information for patient handouts from the Web sites of the Mayo Clinic and the Cleveland Clinic, as well as direct patients to heart.org, diabetes.org, aaos.org, familydoctor.org, or kidshealth.org. To supplement publicly available information, I use professional resources such as uptodate.com, Prescriber's Letter, or Natural Standard. Medical information vendors such as Krames, Zynx, and Healthwise offer high-quality patient education and decision support tools that integrate with EHRs.
Before spending money on health IT options, doctors need to consider the popularity of these choices with patients. For example, how many emails does your practice receive from patients each day?
Appreciation. Patients and doctors both value courtesy. Respect is a two-way street and can be expressed with simple steps, starting with promptness at appointments. Your staff should ask patients how they want to be addressed, make eye contact, and ask about important people or events in the patient's life. Doctors surveyed by Consumer Reports say they appreciate patients who ask questions and challenge treatment recommendations. I also value simple words of thanks and patients who refer family or friends.
Patients appreciate professionalism. This starts with appearance. One patient recently told me she felt doctors and assistants should be dressed professionally every day of the week, in keeping with the high standard of care we aspire to provide. Perhaps we need to reconsider our "casual" Fridays. Other aspects of professional conduct include technical competence, attentive listening, and careful review of patient history and treatment options. …