Patient-Centered Communication: A Strategy to Improve Patient Outcomes Tom Bent, MD Medical Director & COO Laguna Beach Community Clinic President & Board of Directors California Academy of Family Physicians
Learning Objectives Recognize that communication is an essential component of the practitioner s role and has lasting effects over time Discuss the philosophy and proven principles of motivational interviewing that primary care physicians can implement to empower patients to achieve their health goals Demonstrate motivational interviewing as a technique for improving overall adherence to therapies Apply motivational interviewing techniques in typical practice settings with patients who have diabetes or other chronic illnesses and related comorbidities
First Premise: Communication matters Communication is the physician s responsibility Is an essential component of the role Cannot be delegated Has lasting effects over time
First Premise: Communication matters Health outcomes Diagnostic accuracy Adherence Social outcomes Patient satisfaction Physician satisfaction Decreased malpractice risk
Communication improves health outcomes Symptom resolution Psychological stress Health and functional status Blood pressure control Pain control Patient anxiety
Communication improves diagnostic accuracy Quality of clinical data Quantity of clinical data
Communication improves adherence An important predictor of adherence is the interpersonal skill of the physician
Communication improves patient satisfaction Physician understands patient Physician elicits patient s health concerns Patient is comfortable with asking questions Patient perceives sufficient time is spent with the physician
Communication improves physician satisfaction The quality of the physician-patient relationship is the most important predictor of global career satisfaction for physician.
Second Premise: Communication is a Procedure Used most commonly We conduct over 100,000 interviews in our career Communication is a procedure that can be learned Mastering communication requires practice and experience
Tasks for successful communication One Approach to communication: Engage Empathize Educate Enlist
Engagement A connection which continues throughout the encounter Person to person Professionally, as partners
Tools for Engagement Introduce yourself Greet your patient Welcome your patient Maintain eye contact
Tools for Engagement Use the first few minutes to build rapport Use a pleasant, consistent tone of voice Be as curious about the patient as you are about their medical condition Use open ended questions Allow the patient time to tell their story
Tools for Engagement Elicit your patient s agenda Elicit expectations or goals for the encounter Get all the complaints List issues Prioritize
Empathy Patient experiences Being seen Being heard Being accepted Perfect understanding
Tools for Empathy Acknowledge: Facial and body expression Physical presentation Notable physical characteristics See fully clothed new patients Eliminate physical barriers
Tools for Empathy Listen to the patient s story Patient s feelings Patient s values Patient s thoughts and ideas Reflect your understanding Reflective listening List issues
Tools for Empathy Judge the behavior, not the person Normalize when possible Use appropriate self-disclosure Focus on the patient s feelings (empathy) rather than your own reactions (sympathy)
Outcomes of Successful Empathy Improved adherence Increased level of connection and mutual satisfaction Reduced physician frustration Reduced patient anxiety
Education Goals: Greater knowledge and understanding Increased capacity and skills Decreased anxiety
Tools for Education Assess current knowledge What do you think is going on? Why do you think this has happened? What do you understand about your condition? What worries you most?
Answer the mysteries of health What has happened to me? (Diagnosis) Why has it happened? (Etiology) What s going to happen to me? (Prognosis)
Outcomes of successful Education Increased understanding Decreased confusion Decreased anxiety Improved adherence Greater patient and physician satisfaction
Enlistment An invitation from the physician to the patient to collaborate in the decision-making surrounding the problem and the treatment plan
Factors that affect adherence Patient s perception of the seriousness of the condition Patient s perception of the efficacy of the treatment Duration of both the treatment and the illness Complexity and expense of the regimen Relationship with the physician
Tools for Enlistment Assume the patient has an internal belief system regarding his condition that includes the following: Cause and solution Functional meaning Relational meaning Symbolic meaning
Tools for Enlistment Keep regimen simple Tailor treatment to individual s habits and routine Get feedback from the patient Write out the treatment plan Identify and remove obstacles