January 23, 2013

Be Careful of Patient-Centered Clinical Consultations

This is an interesting study for the way it is presented. Yes, it is only a press release and only the abstract is available without a fee. It is interesting because this idea of “patient-centered” is being talked about by clinicians and other physicians,  Until recently, this was not widely discussed other than by patients who wanted doctors to talk with them instead of at them. Patients have wanted to be included in the decision-making and given sources of education to help them understand more about their illness or disease.

We still have many doctors that will not consider patient-centered activity and will not accept patients that are proactive in their care. These doctors are slowly decreasing and many are retiring. More and more doctors are working for patient-centered consultations and even a few are taking it further with shared medical appointments (SMAs) to be able to educate more patients and get patient-to-patient input and interaction. Often this shared time brings on increased satisfaction from patients and allow patients to become more involved and knowledgeable about their illness or disease.

The study does not cover any of the above, but does discuss the communication problems in health care that may arise when providers (generally doctors) focus on diseases and their management. This means that they are not focusing on people (the patients) and their health problems. Patient-centered care in the patient visit is increasingly being sought by the patients, more doctors, and is being incorporated into training for health care providers. The consequences of these interactions on clinical encounters and indirectly on patient satisfaction, health care behavior, and health status has not been properly evaluated.

I will let you read information on the data and collection methods if you desire and move on to the conclusions. Interventions to promote patient-centered care within clinical consultations are effective across studies in transferring patient-centered skills to providers. However the effects on patient satisfaction, health behavior and health status are mixed. There is some indication that complex interventions directed at providers and patients that include condition-specific educational materials have beneficial effects on health behavior and health status. These outcomes have not been assessed in studies reviewed previously.

Training providers has improved their ability to share control with patients and for most patients to have success in consultations with providers that have been trained with new skills. Short-term training of less than 10 hours is as successful as long-term training. Yes, results are mixed at this point and will continue to be until providers are confident that the new skill will work for the long-term. The disappointment has to be the small number of these multi-faceted studies. To have more confidence, more studies are needed. This should help patients and doctors.

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