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By: Carolyn Thomas

Carolyn Thomas — Sat, 23 Mar 2013 18:15:18 +0000

Thanks so much Mark for your thoughtful response. “…the answer to good encounters is to have providers with a listening ear and open mind” – ain’t that the truth?

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By: Mark

Mark — Sat, 23 Mar 2013 15:31:22 +0000

One area of focus in the US (at least in the public sector of healthcare) is shared, informed decision making. Several elements are involved and intuitive:

(1) the provider must be informed…with unbiased information.
(2) the patient must be informed.
(3) both must be willing to participate.
(4) external, non-patient factors have to be minimized.

Some of those external factors do include industry and profit motive. One area I’d like to share is that I see regulatory compliance becoming an uninvited participant in patient-provider encounters.

Example: if a provider is being graded on whether patients get flu shots, there is an incentive for the provider to coerce a patient into getting a flu shot. One can think of this as the Healthcare Agenda…which may or may not align with the patient’s agenda! Metrics of healthcare “quality” (and I put that in quotes because “quality” has different meanings to patients, providers, employers, and third-party payers) often help to improve care.

But they also can create conflict between providers and patients. One could propose getting rid of metrics: but I think that is unrealistic. Perhaps we could find BETTER metrics… a way to truly measure whether patient values and preferences are being honored.

Most of the current metrics are derived from the electronic health record and, as such, tend to be very simplistic (did patient have flu shot, mammogram, etc. or not). We are trying to measure if there is documentation of a patient’s goal in the record. Admittedly, this is a crude and easily “gamed” metric. But perhaps it is a reasonable surrogate for truly shared decisions.

Ultimately, I think, the answer to good encounters is to have providers with a listening ear and open mind. It is hard to legislate that.

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By: Carolyn Thomas

Carolyn Thomas — Sat, 23 Mar 2013 14:19:08 +0000

Hello Marie – as I commented on your post, I’m not sure how I feel about how this will play out. I’m guessing that including the patient voice is such an important step forward that we may have to hold our noses and just be grateful to be included – even when we know industry is only doing it because it makes them look good.

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By: Marie Ennis-O'Connor (@JBBC)

Marie Ennis-O'Connor (@JBBC) — Sat, 23 Mar 2013 14:07:13 +0000

Thanks for sharing – however all the credit goes to you and the others who have highlighted the case and shone a bright light on the pertinent issue of patient engagment tokenism. I have forwarded the discussion not just to patient advocates in my network, but also to my pharma and healthcare public relations contacts who really need to sit up and take notice of what patients really think!

I am fascinated to see how this will play out.

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