Medical Leaders Examine the Benefits of Collaborative Decision Making in Health Care
Patients, doctors can work together to improve outcomes, panelists say
WASHINGTON, D.C., November 13, 2001 — The U.S. medical system historically has placed the lion's share of diagnostic and decision-making power in the hands of treating physicians. But shifting some of the control to patients, and involving them much more collaboratively in their own care, can lead to significant improvement in health care outcomes and patient satisfaction, according to a panel of health industry experts who presented at today's meeting of the Academic Medicine and Managed Care Forum. The conference was convened by Aetna (NYSE: ΑET).
"We need to give up the false notion that the doctor supplies all of the answers," said John H. Wasson, M.D., moderator of one of the Forum's panel discussions. "The patient is the agent of change." Wasson, who is the Herman O. West Professor of Geriatrics in Community and Family Medicine at Dartmouth Medical School, is also the co-director of a national project for "Idealized Design of Clinical Practice." That project is sponsored by the Institute for Healthcare Improvement.
At today's Forum meeting, which was held at the Ritz-Carlton Hotel in Arlington, Va., Wasson joined four other health professionals in a panel discussion entitled, "Interaction is the Heart of Care, But Can it Work Here?"
The other panelists were: Ehab Molokhia, M.D., and Tangela Atkinson M.D., both of whom are chief residents at the University of South Alabama; Cory B. Sevin, R.N., MSN, vice president of La Clinica Campesina Family Health Services; and Col. Jill S. Phillips of the U.S. Army Nurse Corps, who is director of outcomes management and an adult nurse practitioner at the Walter Reed Army Medical Center.
"Today's patients are much savvier about health issues," said Aetna Chief Medical Officer Dr. William Popik, who opened the Forum program. "They see the physician as simply one source, albeit an important one, of information about their health. But patients also get health information from the media, from friends and neighbors, and from alternative care practitioners. And let's not forget the Internet, which has empowered a whole generation of consumers with detailed, but sometimes confusing and contradictory, information."
False images of what leads to good health care make the doctor-patient relationship less effective than it could be, the panel agreed. Among those misconceptions are the notions that health care is delivered primarily during office visits, that health care "demand" is patient-driven, and that the vast amount of health care information available via the Internet is somehow "not right" for patients.
The group discussed ways that medical professionals can make their discussions with patients more productive. "Physicians need to speak less during a patient's visit, and learn active listening techniques," Wasson said. "By putting more emphasis on asking open-ended questions, doctors can better obtain the information that both they and their patients need to bring about a positive outcome."
The panelists also examined strategies to enhance patient/doctor interactions such as providing patient-owned medical records; establishing continuity of care with a clinician or team of clinicians; surveying patients' visit expectations; and making doctor-initiated telephone calls to the patient's home as part of the effort to shift the doctor-patient
relationship from an office-directed model to a collaborative one. E-mail, audiotape and videotape can be effective tools in that process, the group noted.
Edward H. Wagner, M.D., MPH, director of the W.A. MacColl institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative, and the keynote speaker for today's Forum meeting. The focus of his remarks was, "The Scientific Rationale for Collaborative Care."
Other presenters included Albert G. Mulley Jr., M.D., chief of the General Medicine Division, director of the Medical Practices Evaluation Center at Massachusetts General Hospital, and associate professor of Medicine and associate professor of Health Policy at Harvard Medical School; and Annette M. O'Connor, Ph.D., professor at the University of Ottawa School of Nursing and Department of Epidemiology, and senior scientist with the Clinical Epidemiology Program at the Ottawa Health Research Institute.
They made a joint presentation entitled, "Shared Decision Making - Understanding Decision Support and Overcoming Barriers to Implementation."
The luncheon speaker was David M. Lawrence, M.D., chairman and chief executive officer of Kaiser Foundation Health Plan Inc. and Kaiser Family Hospitals, who examined "Health Care in the 21st Century" in his remarks.
The Forum is a unique partnership of many of the nation's top medical institutions working with managed care, major employers, federal agencies, private foundations, pharmaceutical and information technology companies to address significant issues facing medicine today. It provides an arena in which participants can collaborate to enhance the delivery of quality medical care. Working groups, a research fund and semiannual meetings are the three principal components of the Forum.
The Forum today announced the recipients of approximately $4 million in
new grants, bringing the five-year total to more than $30 million.
For more information about Aetna Inc., please visit the company's website at
www.aetna.com.
|
