IMPROVING PATIENT CARE
The Power of Two: Improving Patient Safety Through Better Physician-Patient Communication
Helping patients become more informed and involved in their care could be your best strategy for reducing medical errors.
Fam Pract Manag. 2002 Jul-Aug;9(7):47-48.
One of your most important allies in reducing medical errors is sitting in your waiting room: your patient.
The same Institute of Medicine report that showed as many as 98,000 deaths occur yearly because of medical errors also identified poor doctor-patient communication as one of the root causes.1 Moreover, a recent study sponsored by the Agency for Health-care Research and Quality (AHRQ) found that physicians aren’t doing enough to help their patients make informed decisions.2
What does this mean for family physicians? It means that uninvolved and uninformed patients (or their caregivers) are less likely to accept your choice of treatment and less likely to do what is needed to make the treatment work. It also means that, despite physicians’ best efforts, patients still feel uncomfortable participating in their health care decisions and still have difficulty asking follow-up questions or clarifying matters they don’t understand. And it means that both parties – doctors and patients – are taking each other for granted. Doctors are assuming that patients know which kinds of information they should be sharing (e.g., the names of over-the-counter medications and herbal supplements they are using), and patients are assuming that doctors asking all of the right questions.
In an effort to encourage patients to play a more active role in their health care, AHRQ developed a patient fact sheet called 20 Tips to Help Prevent Medical Errors. The advice is based on evidence that demonstrates the value of patient involvement in their health care. At least half of the tips relate in some way to the doctor-patient interaction. And although the fact sheet was intended to empower patients, there’s much family physicians can do to facilitate and improve communication. This is where the power of two comes in: By working together, doctors and patients can greatly reduce the likelihood of errors.
Put patients at ease
Several of AHRQ’s 20 tips for patients relate directly to their comfort level in talking with physicians. These tips encourage patients to become active members of their own health care team, to speak up if they have any questions and to learn all they can about their condition by talking with health professionals.
But for many patients, assuming a more active role is easier said than done. When asked whether they have any questions, patients often answer “no” or venture only one question, even though they may have many. They may feel anxious from the examination and unable to articulate their questions in the few minutes available. They may worry that their questions are unintelligent or that their physicians are too busy to answer them.
To help your patients become more active and informed, make every effort to set them at ease and to welcome their participation. Communicate to them that no question is too unreasonable and no piece of information is too trivial to share.
Be explicit in your instructions
To avoid harm in health care, it is imperative that patients understand their physicians’ instructions. This implies a patient responsibility (listening to and following orders) as well as a physician responsibility (being clear in your orders). For example, the 20 tips fact sheet advises patients to make sure they can read their prescriptions and understand how to take their medications. Doctors can help by producing legible prescriptions, by explaining how those medications are to be taken and by reviewing medications at subsequent visits. Although many pharmacies provide drug information – such as written circulars that come with a prescription and symbols printed on the medication label – physicians cannot assume their patients will read the information or understand it. It is well worth the extra 1 or 2 minutes to explain to your patient why he or she should take a certain medication with milk, stay out of the sunlight or avoid driving, for example. It is also worth the few additional minutes to identify potential drug interactions, not just with other prescription medications the patient may be taking, but with over-the-counter medications and herbal supplements as well.
In a similar manner, doctors should provide explicit instructions to their patients regarding treatment plans and follow-up care and should review their plans with patients to ensure that they understand what will happen next and their options for care.
Prompt the fullest answers
The 20 tips handout advises patients to “think outside the box” when talking with their doctors about current prescriptions, drug allergies and interactions. But even the most health-savvy patient may not remember or know to tell you of the echinacea an office colleague urged him or her to try for a cold. And while the tips advise patients to “brown bag” it once a year, by bringing all current prescriptions with them to your office, they may neglect to bring the over-the-counter stomach remedy they’ve been using. It is therefore up to you to prompt the fullest answers. For example, instead of asking the general question “Are you taking any drugs?” make your question more specific: “Are you taking any prescription drugs, over-the-counter medications or any herbal supplements?”
Coordinate patient care
Coordination of care is a crucial element in preventing medical errors and is a hallmark of family practice. When your patients require the services of another physician, you are often the key to making sure that all parties are clear on exactly what will happen next in the patient’s care. You can fulfill this role by communicating clearly with the other physicians who become involved in your patient’s care and by staying involved yourself until a solid handoff has been made.
The 20 tips handout advises patients not to assume that every health professional involved in their care knows everything he or she needs to know. Similarly, physicians cannot afford to assume that other physicians or medical staff necessarily have the same information. Discuss vital patient information with your colleagues who may be covering your patients, and make sure that information is available at appointments as well as in times of emergencies.
Perhaps the most important message of the 20 tips document is that both parties – physicians and patients –have an opportunity and a responsibility to prevent medical errors. To help your patients do their part, make the 20 tips fact sheet available to them. You can download a copy below, or order free copies of the fact sheet, including a Spanish version, from the AHRQ Publications Clearinghouse (8003589295 or firstname.lastname@example.org). You can also download the fact sheet from the AHRQ Web site at www.ahrq.gov/consumer/pathqpack.htm. Download it, put your logo on it, and get it into your patients’ hands.
The issue of medical errors can divide physicians and patients if they choose to place blame and become unwilling to trust one another. But by working together, doctors and patients can improve communication and greatly reduce the likelihood of preventable errors.
Dr. Meyer, an internist, is director of the Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. Ms. Arnheim is a consultant to AHRQ.
Conflicts of interest: none reported.
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1. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
2. Boutin-Foster C, Charlson ME. Problematic resident-patient relationships. J Gen Intern Med. 2001;16:750–754.
Copyright © 2002 by the American Academy of Family Physicians.
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