By Muriel R Gillick
J Med Ethics 2015;41:785-788
doi:10.1136/medethics-2014-102618
Abstract
Shared decision-making is widely accepted as the gold standard of clinical care. Numerous obstacles to achieving shared decision-making have been identified, including patient factors, physician factors and systemic factors. Until now, the paradigm is seldom successfully implemented in clinical practice, raising questions about the practicality of the process recommended for its use. A re-engineered model is proposed in which physicians elicit and prioritise patients’ goals of care and then help translate those goals into treatment options, after clarifying the patient's underlying health status. Preliminary evidence suggests that each step of this revised process is feasible and that patients and physicians are comfortable with this strategy. Adoption of this model, after further testing, would allow the goal of shared decision-making to be realised.
The entire article is here.
Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care
Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Shared Accountability. Show all posts
Showing posts with label Shared Accountability. Show all posts
Tuesday, September 22, 2015
Thursday, May 29, 2014
Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems
By Glyn Elwyn, Christine Dehlendorf, Ronald Epstein, Katy Marrin, James White, and Dominick Frosch
doi: 10.1370/afm.1615
Ann Fam Med May/June 2014 vol. 12 no. 3 270-275
Abstract
Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.
The entire article is here.
doi: 10.1370/afm.1615
Ann Fam Med May/June 2014 vol. 12 no. 3 270-275
Abstract
Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.
The entire article is here.
Sunday, May 26, 2013
Owning Our Mistakes
By Nate Kreuter
Inside Higher Ed - Career Advice
Originally published May 15, 2013
Some of the columns that I write here at Inside Higher Ed arise from a really basic formula. It goes something like this: I make a mistake at work. I realize my error, or am compelled by another party to realize it, and I take corrective action. Then I write a column addressing the mistake in general terms, in hopes of perhaps removing a little of the trial and error from this whole higher education gig for a reader or two. Somewhat less frequently I simply observe the mistake of another and then write a column. I probably couldn’t keep up with this column without the steady stream of mistakes I make myself. Maybe my mistakes are job security of a strange sort.
I probably could even use this venue to make a public promise regarding my mistakes to my colleagues in my department, college, university, and across my discipline. Here goes: I promise you all that I’ll screw up again one day. I don’t know exactly how and I don’t know exactly when, but I promise to bungle something. Maybe just in a small way. Maybe in a big way. Who knows?
But here’s what I also promise: I promise to own up to whatever mistakes I make as soon as I recognize them, to do everything in my power to correct them, and to do my damnedest not to repeat them. This is, I think and I hope, what it means to be a good colleague. I certainly would not ask a colleague for more, but I also expect no less.
If to err is human, then 'fessing up is humane. Humane for ourselves and humane for our fellows.
The entire post is here.
Inside Higher Ed - Career Advice
Originally published May 15, 2013
Some of the columns that I write here at Inside Higher Ed arise from a really basic formula. It goes something like this: I make a mistake at work. I realize my error, or am compelled by another party to realize it, and I take corrective action. Then I write a column addressing the mistake in general terms, in hopes of perhaps removing a little of the trial and error from this whole higher education gig for a reader or two. Somewhat less frequently I simply observe the mistake of another and then write a column. I probably couldn’t keep up with this column without the steady stream of mistakes I make myself. Maybe my mistakes are job security of a strange sort.
I probably could even use this venue to make a public promise regarding my mistakes to my colleagues in my department, college, university, and across my discipline. Here goes: I promise you all that I’ll screw up again one day. I don’t know exactly how and I don’t know exactly when, but I promise to bungle something. Maybe just in a small way. Maybe in a big way. Who knows?
But here’s what I also promise: I promise to own up to whatever mistakes I make as soon as I recognize them, to do everything in my power to correct them, and to do my damnedest not to repeat them. This is, I think and I hope, what it means to be a good colleague. I certainly would not ask a colleague for more, but I also expect no less.
If to err is human, then 'fessing up is humane. Humane for ourselves and humane for our fellows.
The entire post is here.
Sunday, January 1, 2012
Inviting Patients to Read Their Doctors' Notes
Patient and Physician
Surveys
Original Research:
Improving Patient Care
Annals of Internal
Medicine
By Jan Walker, RN, MBA;
Suzanne G. Leveille, PhD, RN; Long Ngo, PhD; Elisabeth Vodicka, BA; Jonathan D.
Darer, MD, MPH; Shireesha Dhanireddy, MD; Joann G. Elmore, MD, MPH; Henry J.
Feldman, MD; Marc J. Lichtenfeld, PhD; Natalia Oster, MPH; James D. Ralston,
MD, MPH; Stephen E. Ross, MD; and Tom Delbanco, MD
Abstract
Background: Little is
known about what primary care physicians (PCPs) and patients would expect if
patients were invited to read their doctors' office notes.
Objective: To explore
attitudes toward potential benefits or harms if PCPs offered patients ready
access to visit notes.
Design: The PCPs and
patients completed surveys before joining a voluntary program that provided
electronic links to doctors' notes.
Setting: Primary care
practices in 3 U.S. states.
Participants: Participating
and nonparticipating PCPs and adult patients at primary care practices in
Massachusetts, Pennsylvania, and Washington.
Measurements: Doctors'
and patients' attitudes toward and expectations of open visit notes, their
ideas about the potential benefits and risks, and demographic characteristics.
Results: 110 of 114
participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and
37 856 of 90 203 patients (42%) completed surveys. Overall, 69% to
81% of participating PCPs across the 3 sites and 92% to 97% of patients thought
open visit notes were a good idea, compared with 16% to 33% of nonparticipating
PCPs. Similarly, participating PCPs and patients generally agreed with
statements about potential benefits of open visit notes, whereas
nonparticipating PCPs were less likely to agree. Among participating PCPs, 74%
to 92% anticipated improved communication and patient education, in contrast to
45% to 67% of nonparticipating PCPs. More than one half of participating PCPs
(50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open
visit notes would result in greater worry among patients; far fewer patients
concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83%
to 84% of nonparticipating PCPs anticipated more patient questions between
visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient
enthusiasm extended across age, education, and health status, and 22%
anticipated sharing visit notes with others, including other doctors.
Limitations: Access
to electronic patient portals is not widespread, and participation was limited
to patients using such portals. Response rates were higher among participating
PCPs than nonparticipating PCPs; many participating PCPs had small patient
panels.
Conclusion: Among
PCPs, opinions about open visit notes varied widely in terms of predicting the
effect on their practices and benefits for patients. In contrast, patients
expressed considerable enthusiasm and few fears, anticipating both improved
understanding and more involvement in care. Sharing visit notes has broad
implications for quality of care, privacy, and shared accountability.
Primary Funding Source: The
Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and
Koplow Charitable Foundation.
The entire story is here.
Thanks to Ken Pope for
this story.
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