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The “Other” Physician and Patient Competencies—What’s all the Fuss?

What competencies are needed for physicians and patients/caregivers in the 21st century in order to achieve the triple aim – better patient experience, improved health of populations, and reduced cost in high-performing delivery systems?  This question was posed at the 2012 ABIM Foundation Forum, Choosing Wisely in an Era of Limited Resources.

Why even ask this question?  Traditionally, the ability to diagnose and treat medical conditions has been the paramount competency for physicians. Really, what else is needed? And why speak about competencies of patients and family caregivers? What’s all the fuss?

As research has shown, the relationship between physicians and patients, along with the opportunity to have well-informed conversations, helps improve their quality of care and satisfaction. Examples of this are found in high-performing delivery systems that understand the importance of the physician/patient relationship.

So what did the diverse group of Forum participants – physicians, patients, payers, medical educators and researchers, identify as important competencies for physicians – beyond the need to be an effective diagnostician?

  • Communication skills, including how to engage patients in their care, shared decision-making and how to speak about appropriate care and clinical evidence; 
  • the ability to work in interprofessional teams; and,
  • a focus on using information to optimize the health of a population of patients.

Participants also identified several competencies needed by patients and caregivers to improve their health, including:

  • better health literacy;
  • ability to engage in shared decision-making;
  • knowledge of self-care; and,
  • being empowered and educated to advocate on one’s behalf.

My limited, but growing experience with the health care system (I recently experienced a detached retina in my left eye – my right eye was operated on in November 2011) provides me with a limited but useful perspective.

My surgeon operates at one of the best eye hospitals in the world, but reflecting on the experience, there are a few things I think could be improved to help future patients who may find themselves in a situation like mine:

  • More time spent on educating me about the potential complications of my procedure, and what to do if there are complications. If something were to go wrong, who do I call? Should I go back to the hospital? It wasn’t clear.
  • Provide me with the clinical evidence about the options for surgery, professional opinions on the best course for my situation, and help me to make the best decision for myself.
  • Provide better, clearly written information about when to start and stop my medication and how to administer it.
  • And while this information is being communicated, a wish that the surgeon would sit down when he talks to me.  As a patient I want to feel we are in conversation about my health and that he is fully present with me.

I am glad I went to a world class surgical hospital for diagnosis and treatment, and so far I am recovering as well as can be expected. But those other competencies identified at the Forum will equally influence the outcome of my procedure, and those of future patients entering the health care system.  

Please share your experience as a patient or physician in the comments below.

2 Comments to The “Other” Physician and Patient Competencies—What’s all the Fuss?

  • Mark Gorman's Gravatar Mark Gorman
    September 12, 2012 at 3:53 pm | Permalink

    Daniel,

    I think there is an element in the physician competencies, communication or separately, that is this: supports patients in becoming better patients. The patient competencies you list are essential for a new model of patienthood, but a key question is how will patients acquire them? The best place is as part of their interaction with clinicians. Whether it is coaching, motivational interviewing, self-efficacy-enhancing interviewing techniques, or some other method, the goal is the same: physician competency in supporting patient skill development.

    I would not leave this implicit in the competencies you list. It needs to be an explicit part of clinicians’ modes of interacting with patients.

    Mark

  • JFP's Gravatar JFP
    November 15, 2012 at 11:50 am | Permalink

    Oh my. An open invitation to share my experiences as a patient! And I’ll even toss in my experiences as the caregiver to the Alzheimer’s mom!

    However, not only is there not enough room in this little comment box for this information, I’m also in the middle of writing a paper for my bioethics class – and it’s due in a few days [grad school - LOVE IT!].

    Despite the lack of time and space, I’d like to toss in a couple of thoughts. If I could summarize one of the major issues in physician-patient interactions, I’d have to say that it’s about RISK COMMUNICATION.

    Physicians in general have a poor idea of the concept of risk to begin with, and are often unable to talk about risks with patients in a way that they can understand.

    For their part, patients simply don’t understand RISK. Someone tells them that there’s a 25% chance that they’ll die from something, and they hear either that they’re going to be dead within a month, OR that there’s a 75% chance that they won’t die. Is it because our society has poor math skills in general? I have no idea, but these conversations need to improve.

    And I’ll quickly share a caregiver moment. Mom was sliding down into severe AD, and there were some behavior problems. I told her long-time physician that this was happening, and his response was a very self-satisfied: “we have a number of patients who are in your position – they just do the best they can.” And that was all.

    I’d hoped for some ideas on how to cope with her belligerence, anger, and fear. I’d hoped for some pointers to a resource or two [anywhere!] that might give me some ideas on how to cope. Thank goodness I had the sense to stop putting pills in her mouth – at least that stopped the biting. Of course. I then had to deal with her palming the pills, but that seemed easier somehow, especially with a stash of snickers bars..

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