Oct 27, 2008

Practice Makes Perfect: Patient-Centered Care

Patient-Centered care is one of the six aims in the Institute of Medicine (IOM) report, Crossing the Quality Chasm, and arguably the most important of the six aims. As silly as this may sound, the aim reminds everyone that patients are people too. Patients are in a vulnerable position when they seek care. They are reaching out for advice, assistance, reassurance, support, and expert knowledge. So, the least health care professionals can do is to respect their patients' preferences and work with the patients when delivering care.

After allowing 2nd year medical school student friends of mine examine my severe otitis (fluid in the ear), I now realize that achieving the patient-centered care aim is much easier said than done. As I described my ailment, I slowly felt myself transforming into a specimen with "cool pathology described in textbooks!"

I'll admit that I too was excited to be "examined." After-all, I would be in their shoes in just a few short years. But apprehension soon took over my curiosity as I was reminded that my giggling would make it difficult for them to examine me and was a sign of my noncompliance. This doctor speak quickly changed the mood. I had three of my friends, or rather doctors in the making, stick their otoscopes into my ear in succession.

Friend 1 was very hesitant. She was unable to see what was later described to me as bubbles behind my ear drum until I told her she could probably stick the otoscope farther into my ear. I appreciated her hesitancy, which I translated as a sincere concern for accidentally puncturing my ear drum.

Friend 2 was just the opposite of Friend 1. Friend 2 approached me with palpable confidence. Her eyes glowed with excitement and her hand gripped the otoscope in the same fashion an eager kid holds his spoon when given ice cream. Perhaps she was compensating for her height (something I can relate to since I stand proudly at 5'1"), but she pulled a little too hard on my ear lobe and practically jammed the otoscope into my ear. Only after seeing my pained expression did she say, "Oh, I'm sorry. Please let me know if I'm hurting you."

Friend 3 finally "got it right." Maybe it was because she benefited from watching Friend 1 and Friend 2. She approached me in warm and collected way- not overconfident but definitely in control of the situation. She told me before making any movements to let her know if she was hurting me since it was not supposed to hurt. The otoscope was inserted in a straight path rather than in the wandering multi-directional course Friend 1 and Friend 2 had used. After a few seconds of silence, she said, "Oh, I see it! It does look like a cluster of bubbles behind your ear drum."

I know all three friends will be excellent doctors. They are diligent in their studies, passionate about helping patients, and dedicated to their chosen career journey. But how do you learn exceptional bedside manner? As a patient, I am oftentimes hesitant to question a procedure because I assume that since the doctors are the experts, they know best. How do health care professionals achieve the balance between being a walking encyclopedia of health and ensuring the comfort of their patients?

On the one hand, it takes an active acknowledgment that patients are people too. And, I suppose, on the other hand, it takes practice. So, to Friends 1, 2,and 3, I'm glad to have helped in your medical training by being an example of severe otitis pathology and helping you hone your bedside manner skills. Patient-centered care takes practice to make perfect!

Click here to read an article on the Slate written by a standardized patient about her experience helping 2nd year medical students practice performing physicals. Thanks for sending me this article Emory!

No comments: