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Patient-centred care

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Sharing control of appointment length with patients in general practice: a qualitative study. Familiarity breeds better outcomes. Let’s be clear: familiarity breeds better outcomes.

Familiarity breeds better outcomes

People who have a usual, continuous source of primary medical care generally do better than those who don’t. We know this, and yet everywhere primary care and general practice are in crisis. The United Kingdom is no exception. Its medical schools are “training future doctors for yesterday,” say our editorialists John Oldham and Sam Everington (doi:10.1136/bmj.j294). Only 5.9% of UK medical school professors are GPs. The Heroism of Incremental Care. By 2010, Bill Haynes had spent almost four decades under attack from the inside of his skull.

The Heroism of Incremental Care

He was fifty-seven years old, and he suffered from severe migraines that felt as if a drill were working behind his eyes, across his forehead, and down the back of his head and neck. They left him nauseated, causing him to vomit every half hour for up to eighteen hours. Ask patients “What matters to you?” rather than “What’s the matter?” Sosena Kebede, assistant professor of medicineAuthor affiliationsskebede3@jhmi.edu This can help reframe interactions in a more patient centered way Maureen Bisognano, one of the keynote speakers at this year’s International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden, told delegates that we should ask our patients, “What matters to you?”

Ask patients “What matters to you?” rather than “What’s the matter?”

Rather than, “What is the matter?” The question “What matters to you?” The Values and Value of Patient-Centered Care. + Author Affiliations CORRESPONDING AUTHOR: Ronald M.

The Values and Value of Patient-Centered Care

Epstein, MD, Center for Communication and Disparities Research, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, Ronald_Epstein@urmc.rochester.edu Key Words: Journal of Clinical Nursing Seeing the person behind the patient enhancing the care of older people using a biographical approach. “Nudge” in the clinical consultation – an acceptable form of medical paternalism?

Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health-care setting - Shepherd - 2015 - Health Expectations. Abstract Objective To test the feasibility and assess the uptake and acceptability of implementing a consumer questions programme, AskShareKnow, to encourage consumers to use the questions ‘1.

Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health-care setting - Shepherd - 2015 - Health Expectations

The importance of being different (Family Practice) - McWhinney. Making EBM work for individual patients. Margaret McCartney, general practitioner1, Julian Treadwell, general practitioner2, Neal Maskrey, visiting professor3, Richard Lehman, senior advisory fellow in primary care4Author affiliationsCorrespondence to: M McCartney margaret@margaretmccartney.com Margaret McCartney and colleagues argue that new models of evidence synthesis and shared decision making are needed to accelerate a move from guideline driven care to individualised care A Google Scholar search using the term “evidence based medicine” identifies more than 1.8 million papers.

Making EBM work for individual patients

How Person-Centered Is Your Health Care Organization? The movement to transform the country’s health care delivery system has been underway for several years now, and some moments of truth are approaching.

How Person-Centered Is Your Health Care Organization?

The ultimate success of this monumental effort to improve the way we pay for and deliver care will be measured not only by cost savings, but also by how well payment reform results in better health outcomes and a value-based system that delivers genuinely person-centered care. The Health Care Transformation Task Force—a unique private-sector, multi-stakeholder group whose 42 members represent six of the nation’s top 15 health systems, four of the top 25 health insurers, and leading national organizations representing employers and patients and their families—has been at the forefront of helping to accelerate the pace of this transformation. Model design;implementation, operation and evaluation of care;and genuine partnership between patients and clinicians at the point of care.

Taking patient-centred health care from rhetoric to reality. Patient-centred care is a term that gets bandied about a lot these days.

Taking patient-centred health care from rhetoric to reality

But what does it really mean? Caring with evidence based medicine. Ian Hargraves, designer1, Marleen Kunneman, postdoctoral research fellow1 2, Juan P Brito, assistant professor of medicine1 3, Victor M Montori, professor of medicine1 3Author affiliationsCorrespondence to: V M Montori montori.victor@mayo.edu Using evidence for kind and careful care The task of evidence based medicine is to care for each patient.

Caring with evidence based medicine

The “evidence based” adjective draws attention to the need to explicitly consider clinical research findings in caring for patients.1 In the 25 years since Guyatt first used the term, many tools—such as practice guidelines—have sought to bring evidence based medicine to all. Three recent articles in The BMJ suggest that something got lost along the way and offer solutions.

Toward Preference-Sensitive Guidelines. A survey of primary care patients' readiness to engage in the de-adoption practices recommended by Choosing Wisely Canada. Symptoms as the main problem: a cross- sectional study of patient experience in primary care. Strengths and limitations A major strength of this study was the large number of GPs and patients who agreed to participate.

Symptoms as the main problem: a cross- sectional study of patient experience in primary care

However, substantial numbers of patients chose not to respond to the questionnaire. Consequently, the generalisability may be compromised for young people with fewer years of education and no chronic disease who live alone. As these are all factors which would potentially contribute to dissatisfaction, non-response would tend to bias our results towards lower frequencies and lower differences between patient groups. The setting (Denmark, Western Europe) itself is selected, and we do not know whether the results may apply to other primary-care settings. The study was strengthened by the linkage between GP registrations and patient questionnaires as this procedure ensured that patients could be linked to the individual GPs rather than to the practices.

GP diagnostics have shown large variability, especially for MUS [21]. Comparison with existing literature. Doctor Yearns For Return To Time When Physicians Were 'Artisans' Dr. Abraham Nussbaum argues for medicine to reconnect with its past: Caring for patients should be a calling, not a job, he says. PhotoAlto/Michele Constantini/Getty Images hide caption toggle caption PhotoAlto/Michele Constantini/Getty Images Dr. “Informed choice” in a time of too much medicine—no panacea for ethical difficulties. Minna Johansson, PhD student1 2, Karsten Juhl Jørgensen, senior researcher3, Linn Getz, professor4, Ray Moynihan, senior research fellow5Author affiliationsCorrespondence to: M Johansson minna.johansson@vgregion.se Providing information to enable informed choices about healthcare sounds immediately appealing to most of us.

But Minna Johansson and colleagues argue that preventive medicine and expanding disease definitions have changed the ethical premises of informed choice and our good intentions may inadvertently advance overmedicalisation The idea of informed patients who make reasoned decisions about their treatment based on personal preferences is appealing in a Western cultural context, with its focus on the autonomous individual. Rightly, many doctors now reject paternalism if the patient does not specifically ask for it. Making evidence based medicine work for individual patients. What Do Physicians Tell Patients About Themselves? Iora Health pioneers new primary care model. BURLINGTON — A year ago, Jeffrey Davis had just about given up on going to the doctor. He was tired of waiting for physicians who always ran late, tired of being rushed through appointments, tired of never having diagnoses or treatment plans fully explained.

Then a coworker suggested that Davis, 53, of Haverhill, check out the Iora Health practice in Burlington. There he found the attention, care, and personal interest that was so lacking in his past experiences. Origins - Medicine of the Person. "Medicine of the Person", or rather, "Médecine de la Personne" is the title of a book published in French in 1940, by Dr Paul Tournier, a general practitioner in Geneva. At a period when psychosomatic medicine was in its infancy, he was struck by the fact that the contemporary approach to illness was purely organic, and failed to consider the patient as a whole, with not only a physical dimension but psychological and spiritual dimensions as well.

The possibilities of patient-centered medicine. If Patients Only Knew How Often Treatments Could Harm Them. Photo If we knew more, would we opt for different kinds and amounts of health care? Despite the existence of metrics to help patients appreciate benefits and harms, a new systematic review suggests that our expectations are not consistent with the facts. In the patient’s best interests? Who says? Fiona Godlee, editor in chief, The BMJfgodlee{at}bmj.com “For moral autonomy it is more important to make ‘wrong’ choices than to obey instructions,” writes Michael Fitzpatrick in this week’s Head to Head debate (doi:10.1136/bmj.h5654).

Empowering the elderly in Japan: lessons for home care in Canada. It’s a question that’s been weighing on the minds of health care managers in Canada and many countries around the world: how will society meet the home and community care needs of an aging population? The Paternalism Preference — Choosing Unshared Decision Making. The day after 19-year-old Jerry Canterbury underwent surgical laminectomy, he fell out of bed and became paralyzed from the waist down. His neurosurgeon, William Spence, reoperated to relieve pressure on the spinal cord, restoring most motor function. Ellipsis: Seeing My Way to "No" (Guest Blog by Alan Schroeder) When I asked my optometrist why I needed a dilated eye exam, his answer was… well, at least factually accurate: “So I can see inside the eye!” Smuggling a Beer for My Hospital Patient - The New York Times. My pager went off late one afternoon with a message from the oncology service at my hospital, asking me to see a 70-year-old man with metastatic cancer and trouble breathing.

What is WrapAround? A challenge for new doctors: Focus on the patient, not just the symptoms. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. Five Keys to 'Less Is More' Medicine in the Clinic. Preventing medical overuse and choosing tests and treatments that are appropriate for individual patients requires engaging patients in their care -- and that means helping patients understand that more care is not always better care. Ten Commandments for patient-centred treatment. A Doctor's 'People Skills' Affects Patients' Health.

The 6 questions every good doctor should ask you. Visit-specific expectations and patient-centered outcomes: a literature review. Harvard Studied People For 75 Years & Found That Happiness Comes From One Thing... A patient-initiated voluntary online survey of adverse medical events: the perspective of 696 injured patients and families. Amy Price and Marilyn Mann on the pros of patient peer review. What If Everything You Knew About Disciplining Kids Was Wrong?