Yesterday I was at a monthly TelePresence meeting of the Person Centered Health initiative, a group that started in Canada that’s closely aligned with the Society for Participatory Medicine. At this meeting, some expressed concern that the memes of “person-centered health,” “patient-centered healthcare,” “participatory medicine,” and the like are becoming so overused as to become meaningless. That is, practices and healthcare organizations are claiming to espouse these principles, when in reality they don’t practice that way. Put another way, they talk the talk but don’t walk the walk.
That’s just plain wrong. You shouldn’t get away with pretending to be patient-centered, any more than you should get away with pretending to be in love. So let’s get specific.
My view is that shifting to patient-centered care entails cultural change, which is difficult. Getting there requires a multi-faceted approach. Part of this involves spreading the meme, but this must be followed by education of all stakeholders in the healthcare system. One way to accomplish this is by providing concrete examples (“you know your practice is participatory if…”). Then we’ll be able to measure practices against this list of attributes.
Let’s crowd-source it. How do you separate the participatory from “empty words” people? Here is my starting list of the most important attributes.
- Do you use an electronic medical record?
- Can patients can see their records online?
- When the EMR is being used in the office, is the screen is oriented so patients can see the record while the clinician is using it?
- Are there internet-connected computers and/or free wireless access available for patients/families?
- Do you have a patient/family advisory board?
- Do you listen to them?
- Do you provide online patient services: education, tools, prescription requests, appointment requests, etc.?
- (Hospitals) Do inpatients have free, reliable and modern entertainment systems?
- Can patients/families contribute to the medical record?
- Are patients encouraged to seek health information on the web, offered advice, and given helpful answers to questions about what they find?
- Are intake forms online, prefilled when possible? (Not handwritten on clipboards)
- Do providers appreciate that most care takes place outside the office/hospital? (See Doc Tom Ferguson’s famous “steal these slides“)
- Are providers comfortable saying “I don’t know—let’s find out together”?
- Do providers practice shared decision making with patients and caregivers?
- Are patients encouraged to interact with their providers using secure messaging and other tools besides the telephone?
- Are patients always informed about test results?
- Does every encounter end with the provider asking if there are other questions or concerns?
What do you think? What issues would make you say “BS – you’re not participatory”? Comments please.
(Also: join the Society for Participatory Medicine to support the movement; participate in meetings of the Person Centered Health Community.)