Listen to your patient; he is telling you the diagnosis.
This was what the great physician William Osler taught his students in the late 19th century. His words are still true today. In Osler’s time, most of what physicians dealt with were new or acute conditions. Because of that, determining the diagnosis was paramount.
Today, although we* still struggle with diagnosis and management of acute conditions, we also must deal with a plethora of chronic conditions that require longitudinal care. Because of this, more than ever, we must appreciate the key role the patient and their caregiver† plays in their healthcare.
We have wonderful medical training. We are also surrounded by amazing technologies and brilliant specialists that we can summon at the click of a mouse. However, doctors and other health professionals must understand that we specialize in and are knowledgeable about medicine. But the patient is a specialist in and has special knowledge about him or herself.
For this reason, we should view the patient as a partner in her own health and healthcare. Only the patient can provide that unique perspective.
The importance of listening to patients
First, we must gather information about the patient’s health complaint and the history of their current illness. This fact-gathering exercise is essential to diagnose the patient’s condition.
However, it is essential that we take the time to listen to the patient rather than interrupt after only 12 seconds as studies have shown is typical of physician-patient encounters. We must have a dialog that includes thoughtful questions and reflection. By taking the time to do this properly, we can avoid much unnecessary testing and specialist referrals.
Beyond that, we must listen to the patients to learn details of their perspectives of their health problems and social situations. This includes assessing any barriers they have to health and healthcare.
Without this as a foundation, it is impossible to care for the person before us. Again quoting Osler,
“The good physician treats the disease; the great physician treats the patient with the disease.”
The patient and physician together should set the treatment goals
Once this is done, the patient and physician together, not the physician alone, should set the treatment goals. What outcomes are important to the patient? For example, the patient may wish to play ball with his grandson. Using his controller medications for his chronic lung disease may be our goal, but in this case, it may help him achieve his goal.
In these days of “quality measures”, it is tempting to use medicine’s metrics as a proxy for the patient’s. But patients are much more likely to participate in their care if they are working towards goals that are meaningful to them.
Along those lines, unless the patient is unconscious (or in restraints), no treatment plan can be successful without the patient’s participation. For example, only about half of patients take their prescribed medications.
Studies have shown that patients are much more likely to participate in a care plan if they are involved in developing the care plan and the rationale explained. Involving patients in their care planning and setting health goals involve shared decision-making and require that patients have adequate information to participate in this process.
The patient is an underutilized healthcare resource
In 1976, Warner Slack at Harvard Medical School wrote that
“[T]he largest and least utilized healthcare resource is the patient him/herself.”
Dr. Slack had spent nearly a decade studying computer-mediated patient interviewing. He concluded that patients, as the primary source of their own health information, should be encouraged to provide that information directly to improve care.
In his day, extant technology only permitted those interactions to take place in the physician’s office. Today, however, we have digital health technologies that can acquire data directly from patients in an ongoing way wherever they may be.
By doing this, we can monitor patients’ symptoms, health status, biometric data (such as weight, blood pressure measurement, and blood glucose), and progress against their care plans as often as necessary. This can improve outcomes at a low cost and expand health system capacity to manage more patients.
Patients and caregivers are valuable sources of feedback
Finally, patients and caregivers are valuable sources of feedback. Ideally, we should encourage feedback after every encounter with clinical care. We should learn from the feedback while recognizing that patient satisfaction is only one of many measures of high-quality care.
For example, a patient who was given antibiotics on demand for a viral respiratory infection may be highly satisfied but has received low-quality care. Incorporating patients and families feedback in aggregate through a patient-family advisory committee is also an important way for physicians to hear the patient’s voice.
The figure lists types of information gathering activities in relation to traditional clinical appointments.
Engaged patients are the best partners in their care
Engaged patients are the best partners in their care. This requires us to provide them the data they need to be active participants, including access to their care plans as well as the rest of their medical record.
But we must also provide tools that encourage engagement, including:
- Using a variety of communication modalities (such as e-messaging and video chat)
- Providing easy ways to schedule appointments
- Make it easy for them to request prescription renewals.
By reducing friction in care delivery patients will be more likely to engage in their healthcare. This should lead to the following:
- improvements in clinical outcomes
- reduction in cost
- improved patient and clinician experience
Call to action: Listen to your patients
Osler’s 19th-century admonitions have enduring relevance even today. But I propose we extend Osler’s maxim to reflect the realities of modern healthcare:
“Engage the patient; she is not only telling you the diagnosis but is integral to all aspects of her health and healthcare.”
[*] I have written this in the first person plural from the perspective of a physician, but it equally applies to other clinicians.
[†] In the remainder of this paper, I have omitted mention of the caregiver, but that should be assumed.
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This post was first published on April 3, 2017, as a part of our partnership with Health Rosetta Principles. It has been reviewed and updated for republication.
Danny Sands, MD, MPH
Danny Sands, MD, MPH is passionate about healthcare transformation, non-visit based care, collaboration in healthcare, and participatory medicine. For over 20 years, he has worked at the intersection of healthcare, technology, and business.
His career began at Beth Israel Deaconess Medical Center, where he trained in clinical informatics and went on to develop and implement numerous systems to improve clinical care delivery and patient engagement. He then became the chief medical officer for Zix Corporation. In that role, he helped the company become a leader in secure e-mail and e-prescribing.
He then served as chief medical informatics officer at Cisco providing both internal and external health IT leadership and helping key customers with business and clinical transformation using IT.
Dr. Sands is currently a popular speaker and consultant working with a portfolio of innovative companies, who blogs at DrDannySands.com.