Couples Therapy for Health Care? Maybe !

Everyone working on the BIF/RISD Healthcare Innovation Project agrees that the relationship between patients and primary care physicians needs improvement. But where do you start? The answer may not be obvious to the experts who typically study American healthcare, but it's crystal clear to the designers leading the BIF/RISD team: talk to the customers.

No surprise, then, that immediately after a review of current research, the team got to work developing a survey and interview methodology that captures firsthand how patients interact with primary care providers.

To start, the team created a set of questions that describe a patient's experience as it directly relates to how he or she seeks and receives primary care services. Team leader Michael Lye suggested that the patient being interviewed first comment on his or her daily routine and background: things like nutrition, exercise, job, stress level, age, and even perceptions of their own health. Background information obtained from these questions will help the team create composite patient archetypes that represent a few "standard" types of patient experiences.

So what kind of questions would you ask to get deeper information about the quality or details of a patient's interaction with his or her primary care doctor? More Dr. Phil than medical, the questions are familiar to anyone who has helped a friend understand any relationship: How often do you see her? How do you feel when you're with her? Are you comfortable with her? Do you trust her? How does she respond to you? How do you feel after a typical interaction with her?

Any relationship has its courtship phase, too, and the team will ask questions about what first brought the patient together with his or her doctor: How did you find him? Did you choose him? What do you look for in a primary care provider? And why did you need to go to him in the first place?

There are also questions that address medical-specific issues that patients don't find in their other relationships (hopefully!). Participants will be asked to comment on follow-up care, visits to the emergency room, and sources of information about their health. Patients will be asked about the physical environment of their care: How do waiting rooms make you feel? How does your reaction to the waiting room compares to experiences in the emergency room or a hospital room?

The team also recognized that a meaningful and honest discussion about any healthcare topic requires acknowledging the role insurance plays in defining any experience a person has relating to medical care. How patients perceive their primary care is wrapped up in how they interact with insurance coverage and administration - or how they deal without it.

Patients are also offered the opportunity to give their general thoughts on healthcare, including their feelings about the system, descriptions of their best and worst experiences, and their views of the biggest flaws and challenges facing healthcare in America.

Of course, any relationship story has at least two sides and the team has prepared a questionnaire for the assistants, nurses and doctors which make up the other half of the primary care experience. Physicians will be asked to comment about a range of topics related to patient care, including their communication with patients, characteristics of office visits, details of referral to medications and specialists and handling of medical records. They will also have a chance to share their subjective feelings about medicine with the team: Why did you go into primary care? How do you think patients perceive you? How would you improve the patients' experience?

Merely by asking these questions about the patient – physician relationship, the team is breaking new ground. By looking at primary care as the relationship between two human beings, a set of interactions between peers, the project asks: how empowered is the patient to be an equal partner in her care?

Posted October 23, 2006 02:09 PM by Allan Tear | Permalink