Macy Foundation Research

Report on Patients as Full Health Care Partners Mirrors Family Medicine's Vision

June 25, 2014 04:20 pm Sheri Porter

A new report issued by the Josiah Macy Jr. Foundation calls on physicians, health care professionals and educators to welcome patients and their families as full and equal partners in health care.

[Torso view of doctor shaking hands with woman]

The report, titled Partnering with Patients, Families, and Communities: An Urgent Imperative for Health Care(, highlights four broad recommendations crafted by participants at a conference convened by the Macy Foundation in early April in Arlington, Va., and identifies specific implementation steps.

In a June 17 press release(, Macy Foundation President George Thibault, M.D., urged those involved in health care to not settle for simply asking patients to respond to surveys and inviting them to serve on advisory panels.

Instead, "We must move beyond what we typically think of as 'patient-engagement efforts' … and integrate patients and families as partners throughout the health professions education and delivery system," said Thibault.

"Although this will require a fundamental shift in traditional health professions education and clinical practice and may even cause some initial discomfort, it is a shift that is urgently needed," he added.

Story highlights
  • A new report from the Josiah Macy Jr. Foundation calls on U.S. health care education and delivery system leaders to better integrate patients and families as partners.
  • The report makes four broad-based recommendations in the areas of enhancing education, revising organizational focus, building the capacity for partnerships, and facilitating regulatory and payment reforms that support partnerships.
  • Family medicine pioneered the concept of patient engagement many years ago and has since strengthened its support of the physician-patient partnership by embracing the patient-centered medical home model of care.

Specifically, the report urged those responsible for reforming and improving the nation's health care system to

  • change the content and conduct of health professions education to graduate physicians and other health care professionals who are willing and able to partner with patients, families and communities;
  • transform health professions education and health care organizations to facilitate durable partnerships with patients, families and communities;
  • build the capacity for partnerships among patients, families and communities and health professions education and health care organizations; and
  • facilitate regulatory and payment reforms that require, support and sustain partnerships among all of those groups.

The report noted that the recommendations were "interdependent and of equal importance; no single recommendations takes precedence."

Stan Kozakowski, M.D., director of the AAFP Division of Medical Education, applauded the Macy report's recommendations and pointed out that family medicine pioneered patient engagement efforts years ago.

"Family physicians have long recognized that the most important aspect of care is the relationship between the physician, the patient and family, and the community in which they live," said Kozakowski in an interview with AAFP News.

"The recommendations made in this report should come as no surprise to experienced family physicians because relationship-based health care has always been the heart and soul of family medicine," he added.

Indeed, the Academy's commitment to the patient-centered medical home (PCMH) model of care is clear evidence of that approach. By definition, the PCMH model facilitates partnerships between patients, physicians and families. Furthermore, according to the AAFP, the PCMH model "seeks to foster a relationship of trust between the care team and the patient, and to actively engage patients as partners in their health care."

But family physicians' ability to engage their patients predates, by many years, the development of the formal Joint Principles of the Patient-Centered Medical Home(3 page PDF) in 2007.

In fact, Kozakowski recalled a 1997 research paper titled "Competency-based Education in Family Practice"( that he co-authored with two family medicine colleagues as part of a task force on competency-based education created by the Society of Teachers of Family Medicine.

"At that time, our intention was to identify the core attributes of effective family physicians," said Kozakowski. He noted that the No. 1 fundamental skill the research team identified nearly two decades ago was the ability of a family physician to conduct a patient encounter that recognized the primacy of a patient's needs and that treated the patient as an appropriately equal health care partner.

"The phrase 'appropriately equal health care partner' mirrors a key element of this current Macy report," said Kozakowski.

"Congratulations to the Macy committee for calling this out because it is so critical to delivering effective care and to meeting the needs of the patient, family and communities," said Kozakowski. "If we don't treat these groups as partners, we'll never be able to achieve the success in health and wellness that we all strive for," he added.

"In order to change the health care system to deliver on the triple aim (improving population health, enhancing the patient experience and controlling costs) every health care professional within the health care system has to embrace the principles that those of us practicing family medicine have always focused on," said Kozakowski.

Perhaps the most telling testimonial to family medicine's having long ago made the right decision in embracing patients and their families as full partners in health care? "The larger medical community now is beginning to recognize that relationships and partnerships are essential to the country's ability to achieve its health care goals," Kozakowski noted.

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