Click to enlarge Source: Weiner SJ, Schwartz A, Sharma G, et al. Patient-centered decision making and health care outcomes: an observational study. Ann. Intern. Med. 2013;158(8):573–9. [Accessed November 3, 2014].
In my last post on listening ( see: Just Read: Just 6 more seconds of listening needed to elicit the patient’s agenda | Ted Eytan, MD ) I said I couldn’t find a newer study than 1999 … and then I met the author of this paper, Saul Weiner, MD, at the Center for Total Health (@KPTotalHealth) via an intro by Alan Spiro, MD (@AlanHSpiro), who it turns out is studying patient-physician communication, and steered me to this paper.
Cool technique: concealed recorders
As with the previous papers I reviewed, this study involved the audio recording of patient-physician visits, with a twist. With prior physician consent, patients were randomized to bring in a concealed recording device without the physician’s knowledge for a particular visit. I’m imagining a patient checking in for their doctor visit and then being approached by a research assistant to slip a recorder in their pocket. Patients do want to help if we let them 🙂 .
403 encounters were analyzed which contained a total of 548 “red flags” “including missed appointments; nonadherence with medications; poor control of a chronic condition, or lack of follow-through with laboratories, tests, or referrals.” Audio recordings were also screened for red flags (“Doc, I can’t afford these pills”).
What the researchers were ultimately able to discover after studying physician response to these red flags and following up in the patient chart was whether:
- A context-senstive care plan was developed
- An improved outcome was the result (more appointments made, better adherence to plan)
patients with a contextualized care plan were more likely to have a positive outcome (odds ratio [OR], 3.7 [95% CI, 1.2 to 11.4]; P 0.021)…When the patient had seen the same resident at their most recent visit, they were more likely to have a positive outcome than when they had seen a differ- ent physician, regardless of whether the care plan was con- textualized (OR, 3.0 [CI, 1.0 to 8.9]; P 0.044).
It’s a little hard to visualize this with a chart since there are many dimensions; I did my best.
So there you have it, listening for 6 seconds longer elicits the patient’s agenda, and listening and planning in the context of the patient results in agendas with less problems down the road.