Doctor-Patient Relationship and Medical Professionalism

1
Doctor-Patient Relationship and Medical
Professionalism

• Holly J. Humphrey, MD
• Dean for Medical Education
• The University of Chicago Pritzker School of
  Medicine

2
Framing the Issue

• The 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
3
ACGME Competencies

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

ACGME Outcome Project, 1999
4
Framing the Issue

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

Bayer-Fetzer Conference on Physician-Patient
Communication in Medical Education, 1999
5
Etiquette Based Medicine

• Checklist for first meeting with a hospitalized
• patient
• 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
6
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
7
Example

• The University of Chicago FACE Card Program

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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.

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Description FACE CardsSide 1
10
Description FACE CardsSide 2
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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.

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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.

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Sample Comments

• This doctor made such an impression on me that
  Im 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.

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AAMC Survey Curricular Content
1980 2000
Communication 47 80
Geriatrics 82 95
Death/Dying 96
Cultural Competence 70
AAMC Medical Educations Quiet Revolution
15

• 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 childs health as I do.
• J. Schlucter
• Mother of 2
• Both children with cystic fibrosis