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Doctor-Patient Relationship and Medical Professionalism Holly J. Humphrey, MD Dean for Medical Education The University of Chicago Pritzker School of Medicine

Doctor-Patient Relationship and Medical Professionalism

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Doctor-Patient Relationship and Medical Professionalism. Holly J. Humphrey, MD Dean for Medical Education The University of Chicago Pritzker School of Medicine. Framing the Issue. The Physician Charter Principles include: Primacy of patient welfare Patient autonomy - PowerPoint PPT Presentation

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Page 1: Doctor-Patient Relationship and Medical Professionalism

Doctor-Patient Relationship and Medical Professionalism

Holly J. Humphrey, MDDean for Medical Education

The University of Chicago Pritzker School of Medicine

Page 2: Doctor-Patient Relationship and Medical Professionalism

Framing the IssueThe Physician Charter

Principles include:• Primacy of patient welfare • Patient autonomy

Commitments include:• Honesty with patients• Patient confidentiality• Maintaining appropriate relationships with patients

ABIMF, ACP, EFIM 2001

Page 3: Doctor-Patient Relationship and Medical Professionalism

ACGME Competencies

• Patient Care• Medical Knowledge• Practice-Based Learning and Improvement• Interpersonal and Communication Skills• Professionalism• Systems-Based Practice

ACGME Outcome Project, 1999

Page 4: Doctor-Patient Relationship and Medical Professionalism

Framing the Issue

• Seven Essential Elements in Physician-Patient Communication– Build the doctor-patient relationship– Open the discussion– Gather information– Understand the patient’s perspective– Share information– Reach agreement on problems and plans– Provide closure

Bayer-Fetzer Conference on Physician-Patient Communication in Medical Education, 1999

Page 5: Doctor-Patient Relationship and Medical Professionalism

Etiquette Based MedicineChecklist for first meeting with a hospitalizedpatient:• Ask permission to enter the room; wait for an

answer• Introduce yourself, showing ID badge• Shake hands (wear gloves if needed)• Sit down. Smile if appropriate• Briefly explain your role on the team• Ask the patient how he/she is feeling about

being in the hospital

Kahn MW, N Eng J Med, 2008

Page 6: Doctor-Patient Relationship and Medical Professionalism

Doctor-Patient Relationship Linked to Outcomes of Care

• Sustained physician-patient partnerships with bonds of trust and knowledge of patients were correlates of three outcomes of care– Adherence– Satisfaction– Improved health status

Safran DG et al, J of Fam Practice, 1998

Page 7: Doctor-Patient Relationship and Medical Professionalism

Example

The University of Chicago FACE Card Program

Page 8: Doctor-Patient Relationship and Medical Professionalism

The University of Chicago FACE Card Program

BACKGROUND Patients admitted to

academic teaching hospitals are often cared for by teams made up of multiple physicians at varying levels of training. Potential for confusion, possible misrepresentation.1.2

Patients are in a unique position to evaluate the professional behavior of their inpatient physicians.

OBJECTIVES To help patients identify

and evaluate their inpatient physicians.

To collect patient evaluations of the professional behaviors of their inpatient physicians.

Page 9: Doctor-Patient Relationship and Medical Professionalism

Description: FACE CardsSide 1

University of Chicago Hospital

General Medicine Service

Dr. Brian CallenderMedical Intern

Comments

Dr. Brian CallenderMedical Intern

Page 10: Doctor-Patient Relationship and Medical Professionalism

Description: FACE CardsSide 2

Evaluation Key

Communication- How well did this person communicate with you and your family? Did they offer to answer your questions?

Compassion- Was this person sensitive to your and your family’s needs?

Respectfulness- Did this person ask and respect your choices about your care?

Responsibility- Did you feel this person acted appropriately on your behalf?

Rate from 0 to 100…

1. Communication

2. Compassion

3. Respectfulness

4. Responsibility

SCALE

100-Best Possible 90-Excellent 80-Very Good 70-Good 60-Above Average 50-Average 40-Below Average 30-Poor 20-Very Poor 10-Terrible 0-Worst Possible

Page 11: Doctor-Patient Relationship and Medical Professionalism

FACE Card Procedure• During attending rounds for new patients, the team members place their card in the corresponding spot in the plastic card holder.

Team members give card holder to the patient and explain the project to the patient, asking him or her to rate the physicians.

Page 12: Doctor-Patient Relationship and Medical Professionalism

FACE Card Procedure• FACE envelopes used for the collection of FACE

cards are placed in patients’ charts in front of discharge papers by unit secretaries.

• Reports for physicians are generated from completed evaluations.

• Reports go into a portfolio for viewing by trainee during structured quarterly feedback session with PD or chief.

Page 13: Doctor-Patient Relationship and Medical Professionalism

Sample Comments

• “This doctor made such an impression on me that I’m now going to switch her for my primary doctor. She was everything a successful, caring doctor should be…. I feel like I just found the most perfect doctor.”

• “Excellent young doctor. Very caring and sweet!”

• “While I believe this doctor cared for me excellently… most of the time I felt I was in the dark about what was happening. I never had a chance to ask questions until the end– mostly because everyone was always in such a hurry to get away.”

Page 14: Doctor-Patient Relationship and Medical Professionalism

AAMC Survey: Curricular Content

1980 2000

Communication 47% 80%

Geriatrics 82% 95%

Death/Dying 96%

Cultural Competence

70%

AAMC Medical Education’s Quiet Revolution

Page 15: Doctor-Patient Relationship and Medical Professionalism

“I want the doctors of tomorrow to know that when all the formal teaching is over and I walk into your office my need is for medical care for my child, but my desperate hope is that you have the same stake in my child’s health as I do.”

J. SchlucterMother of 2Both children with cystic fibrosis