Enriching the Doctor-Patient Relationship by Inviting the Patient's Perspective
Abstract
▪ Doctors and patients alike are saddened and angered by the distance that increasingly interferes with their interactions. Two complementary strategies may enhance the human quality of clinical care and improve outcomes. First, the doctor and patient can undertake a systematic "patient's review" that addresses seven dimensions of care: 1) respect for patient's values, preferences, and expressed needs; 2) communication and education; 3) coordination and integration of care; 4) physical comfort; 5) emotional support and alleviation of fears and anxieties; 6) involvement of family and friends; and 7) continuity and transition. Incorporating the "review" into the clinical encounter encourages both patient and doctor to confront individual preferences and values and offers patients an explicit framework for participating actively in their care. Second, using survey instruments designed to solicit focused reports from patients that address each dimension of care, doctors can gather aggregate feedback about their practices. Such reports move beyond anecdote and can serve as screening tests that uncover areas in doctors' practices that merit improvement. In addition, patients can join doctors in developing solutions to problems uncovered by patients' reports.
References
- 1.
Broyard A . Doctor, talk to me. New York Times Magazine. 26 Aug 1990:33. Google Scholar - 2.
Cleary P ,Edgman-Levitan S ,Roberts M ,Moloney T ,McMullen W ,Walker J , andDelbanco T . Patients evaluate about their hospital care: a national survey. Health Aff. 1991;10:254-67. CrossrefGoogle Scholar - 3.
Matthews D andFeinstein A . A review of systems for the personal aspects of patient care. Am J Med Sci. 1988;295:159-71. CrossrefMedlineGoogle Scholar - 4.
Baron R . An introduction to medical phenomenology: I can't hear you while I'm listening. Ann Intern Med. 1985;103:606-11. LinkGoogle Scholar - 5.
Putnam S ,Stiles W ,Jacob M , andJames S . Patient exposition and physician explanation in initial medical interviews and outcomes of clinic visits. Med Care. 1985;23:74-83. CrossrefMedlineGoogle Scholar - 6.
Ende J ,Kazis L ,Ash A , andMoskowitz M . Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Int Med. 1989;4:23-30. CrossrefMedlineGoogle Scholar - 7.
Strull W ,Lo B , andCharles G . Do patients want to participate in medical decision making? JAMA. 1984;252:2990-4. CrossrefMedlineGoogle Scholar - 8.
Brody D . The patient's role in clinical decision-making. Ann Intern Med. 1980;93:718-22. LinkGoogle Scholar - 9.
Linn L ,DiMatteo M ,Chang B , andCope D . Consumer values and subsequent satisfaction ratings of physician behavior. Med Care. 1984;22:804-12. CrossrefMedlineGoogle Scholar - 10.
Brody D ,Miller S ,Lerman C ,Smith D , andCaputo G . Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4:506-11. CrossrefMedlineGoogle Scholar - 11.
Wartman S ,Morlock L ,Malitz F , andPalm E . Patient understanding and satisfaction as predictors of compliance. Med Care. 1983;21:886-91. CrossrefMedlineGoogle Scholar - 12.
Hathaway D . Effect of preoperative instruction on postoperative outcomes: a meta-analysis. Nurs Res. 1986;35:269-75. CrossrefMedlineGoogle Scholar - 13.
Carter W ,Inui T ,Kukull W , andHaigh V . Outcome-based doctor-patient interaction analysis. II. Identifying effective provider and patient behavior. Med Care. 1982;20:550-66. CrossrefMedlineGoogle Scholar - 14.
Greenfield S ,Kaplan S ,Ware J ,Yano E , andFrank H . Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448-57. CrossrefMedlineGoogle Scholar - 15.
Kaplan S ,Greenfield S , andWare J . Assessing the effects of physician-patient interaction on the outcomes of chronic disease. Med Care. 1989;27:S110-27. CrossrefMedlineGoogle Scholar - 16.
Coser R . Authority and decision making in a hospital: a comparative analysis. Amer Socio Rev. 1958;23:56-63. CrossrefGoogle Scholar - 17.
Berwick D ,Godfrey A , andRoessner J . Curing Health Care: New Strategies for Quality Improvement. San Francisco: Jossey-Bass; 1990. Google Scholar - 18.
Palmer R ,Strain R ,Rothrock J , andHsu L . Evaluations of operational failures in clinical decision making. Med Decis Making. 1983;3:299-310. CrossrefMedlineGoogle Scholar - 19.
Check W . Results are better when patients control their own analgesia. JAMA 1982;247:945-7. CrossrefMedlineGoogle Scholar - 20.
Marks R andSachar E . Undertreatment of medical inpatients with narcotic analgesics. Ann Intern Med. 1973;78:173-81. LinkGoogle Scholar - 21.
Puntillo K . Pain experiences of intensive care unit patients. Heart Lung. 1990;19:526-33. MedlineGoogle Scholar - 22.
Stewart M . Social support: diverse theoretical perspectives. Soc Sci Med. 1989;28:1275-82. CrossrefMedlineGoogle Scholar - 23.
Scheier M ,Magovern G ,Abbott R ,Matthews K ,Owens J , andLefebvre R . Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being. J Person Soc Psych. 1989;57:1024-40. CrossrefMedlineGoogle Scholar - 24.
Kulik J andMahler H . Effects of preoperative roommate assignment on preoperative anxiety and recovery from coronary-bypass surgery. Health Psych. 1987;6:525-43. CrossrefMedlineGoogle Scholar - 25.
Doherty W ,Schrott H ,Metcalf L , andIasiello-Vailas L . Effect of spouse support and health beliefs on medication adherence. J Fam Prac. 1983;17:837-41. MedlineGoogle Scholar - 26.
Evans R ,Matlock A ,Bishop D ,Stranahan S , andPederson C . Family intervention after stroke: does counseling or education help? Stroke. 1988;19:1243-9. CrossrefMedlineGoogle Scholar - 27.
Grieco A ,Garnett S ,Glassman K ,Valoon P , andMcClure M . New York University Medical Center's Cooperative Care Unit: patient education and family participation during the hospitalization—the first ten years. Patient Educ Couns. 1990;15:3-15. CrossrefMedlineGoogle Scholar - 28.
Salz C ,McVey L ,Becker P ,Feussner J , andCohen H . Impact of a geriatric consultation team on discharge placement and repeat hospitalization. Gerontologist. 1988;28:344-50. CrossrefMedlineGoogle Scholar - 29.
Smith D ,Weinberger M ,Katz B , andMoore P . Postdischarge care and readmissions. Med Care. 1988;26:699-708. CrossrefMedlineGoogle Scholar - 30.
Weinberger M ,Smith D ,Katz B , andMoore P . The cost-effectiveness of intensive postdischarge care. Med Care 1988;26:1092-102. CrossrefMedlineGoogle Scholar - 31.
Greenfield S ,Kaplan S , andWare J . Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520-8. LinkGoogle Scholar - 32.
Kaplan S ,Greenfield S , andWare J . Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110-27. CrossrefMedlineGoogle Scholar - 33.
Starfield B ,Wray C ,Hess K ,Gross R ,Birk P , andD'Lugoff B . The influence of patient-practitioner agreement on outcome of care. Am J Public Health. 1981;71:127-31. CrossrefMedlineGoogle Scholar - 34.
Kaplan S ,Greenfield S , andWare J . Impact of the doctor-patient relationship on the outcomes of chronic disease. In: Stewart M, Boter D, eds. Communicating with patients in medical practice. Beverly Hills, California: Sage Publications; 1990:228-45. Google Scholar - 35.
Bedell S andDelbanco T . Choices about cardiopulmonary resuscitation in hospital. When do physicians talk with patients? N Engl J Med. 1984;310:1089-93. CrossrefMedlineGoogle Scholar - 36.
Shmerling R ,Bedell S ,Lilienfeld A , andDelbanco T . Discussing cardiopulmonary resuscitation: A study of elderly outpatients. J Gen Intern Med. 1988;3:317-21. CrossrefMedlineGoogle Scholar - 37.
Calkins D ,Rubenstein L ,Cleary P ,Davies A ,Jette A , andFink A . Failure of physicians to recognize functional disability in ambulatory patients. Ann Intern Med. 1991;114:451-4. LinkGoogle Scholar - 38.
Matthews D ,Sledge W , andLieberman P . Evaluation of intern performance by medical inpatients. Am J Med. 1987;83:938-44. CrossrefMedlineGoogle Scholar - 39.
Brody D . Feedback from patients as a means of teaching the nontechnological aspects of medical care. J Med Educ. 1980;55:34-41. MedlineGoogle Scholar - 40. . Medical Malpractice: Report of the Secretary's Commission on Medical Malpractice. Washington, DC: U.S. Government Printing Office: 1973;67-81. DHEW publication no. (05) 73-88. Google Scholar
- 41.
Arnold R ,Forrow L , andBarker L . Medical ethics and patient-physician communication. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview. New York: Springer-Verlag; [In press]. Google Scholar - 42.
Cassell E . Talking with Patients. 2 volumes. Cambridge, Massachusetts: MIT Press; 1985. Google Scholar - 43.
Lipkin M ,Quill T , andNapodano R . The medical interview: a core curriculum for residents in internal medicine. Ann Intern Med. 1984;100:277-84. LinkGoogle Scholar - 44.
Stoeckle J , ed. Encounters between patients and doctors: an anthology. Cambridge, Massachusetts:MIT Press; 1987. Google Scholar - 45.
Donnelly W . Medical language as symptom: doctor talk in teaching hospitals. Perspect Biol Med. 1986;30:81-94. CrossrefMedlineGoogle Scholar - 46.
Smith R andHoppe R . The patient's story: integrating the patient-and physician-centered approaches to interviewing. Ann Intern Med. 1991;115:470-7. LinkGoogle Scholar - 47.
Kass L . Practicing ethics: where's the action? Hastings Cent Rep. 1990;20:5-12. CrossrefMedlineGoogle Scholar - 48.
Candib L . What doctors tell about themselves to patients: Implications for intimacy and reciprocity in the relationship. Fam Med. 1987;19:23-30. MedlineGoogle Scholar - 49.
Donabedian A . The end results of health care: Ernest Codman's contribution to quality assessment and beyond. Milbank Q. 1989;67:233-56. CrossrefMedlineGoogle Scholar - 50.
Donabedian A . Evaluating the quality of medical care. Milbank Q. 1966;44:166. CrossrefGoogle Scholar - 51.
Cleary P andMcNeil B . Patient satisfaction as an indicator of quality of care. Inquiry. 1988;25:25-36. MedlineGoogle Scholar - 52.
Meterko M ,Nelson E , andRubin H , eds. Patient Judgements of Hospital Quality: Report of a Pilot Study. Med Care. 1990;28(Suppl):S1-S44. MedlineGoogle Scholar - 53.
Kaplan S andWare J . The patient's role in health care quality and assessment. In: Goldfield N, Nash DB, eds. Providing Quality Care: The Challenge to Physicians. Philadelphia: American College of Physicians; 1989:25-68. Google Scholar
This content is PDF only. To continue reading please click on the PDF icon.
Author, Article, and Disclosure Information
Thomas L. Delbanco,
From the Beth Israel Hospital, Boston, Massachusetts. For the current author address, see end of text.
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
*All comments submitted after October 1, 2021 and selected for publication will be published online only.