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 Commitments include: Honesty with patients Patient confidentiality Maintaining appropriate relationships with patients ABIMF, ACP, EFIM 2001

ACGME Competencies Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value ACGME Outcome Project, 1999

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

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

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 Physicians’ comprehensive (whole person) knowledge of patients and patients trust in their physician were the variables most strongly associated with adherence, and trust was the variable most strongly associated with patients’ satisfaction with their physician. Safran DG et al, J of Fam Practice, 1998

The University of Chicago FACE Card Program Example The University of Chicago FACE Card Program

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.

Description: FACE Cards Side 1

Description: FACE Cards Side 2

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.

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. At discharge, nurses use FACE envelope from chart and indicate: Plastic holder not in room FACE cards not in plastic holder Patient unable to complete evaluations Evaluations are included in envelope Envelopes put in the locked collection box located in the nurses’ station & collected by the project coordinator.

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.” **I WOULD RECOMMEND THIS DOCTOR ANY DAY TO SOMEONE OR MYSELF AGAIN **THIS DOCTOR IS VERY POISED AND COMMUNICATES VERY WELL. HE WAS UP TO DATE ON ALL THE CLINICAL DATA REGARDING MY CASE. HE IS VERY LIKEABLE AND WILL BE A GREAT ATTENDING **THANK YOU. YOU ALL MADE ME COMFORTABLE

AAMC Survey: Curricular Content 1980 2000 Communication 47% 80% Geriatrics 82% 95% Death/Dying 96% Cultural Competence 70% AAMC Medical Education’s Quiet Revolution

“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. Schlucter Mother of 2 Both children with cystic fibrosis