Doctor-Patient Relationship and Medical Professionalism

1. Doctor-Patient Relationship and Medical Professionalism Holly J. Humphrey, MD Dean for Medical Education The University of Chicago Pritzker School of Medicine

2. Framing the Issue The Physician Charter Principles include: • Primacy of patient welfare • Patient autonomy Commitments include: • Honesty with patients • Patient confidentiality • Maintaining appropriate relationships with patients ABIMF, ACP, EFIM 2001

3. ACGME Competencies • Patient Care • Medical Knowledge • Practice-Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-Based Practice ACGME Outcome Project, 1999

4. Framing the Issue • Seven Essential Elements in Physician-Patient Communication • Build the doctor-patient relationship • Open the discussion • Gather information • Understand the patient’s perspective • Share information • Reach agreement on problems and plans • Provide closure Bayer-Fetzer Conference on Physician-Patient Communication in Medical Education, 1999

5. Etiquette Based Medicine Checklist for first meeting with a hospitalized patient: • Ask permission to enter the room; wait for an answer • Introduce yourself, showing ID badge • Shake hands (wear gloves if needed) • Sit down. Smile if appropriate • Briefly explain your role on the team • Ask the patient how he/she is feeling about being in the hospital Kahn MW, N Eng J Med, 2008

6. Doctor-Patient Relationship Linked to Outcomes of Care • Sustained physician-patient partnerships with bonds of trust and knowledge of patients were correlates of three outcomes of care • Adherence • Satisfaction • Improved health status Safran DG et al, J of Fam Practice, 1998

7. Example The University of Chicago FACE Card Program

8. BACKGROUND Patients admitted to academic teaching hospitals are often cared for by teams made up of multiple physicians at varying levels of training. Potential for confusion, possible misrepresentation.1.2 Patients are in a unique position to evaluate the professional behavior of their inpatient physicians. OBJECTIVES To help patients identify and evaluate their inpatient physicians. To collect patient evaluations of the professional behaviors of their inpatient physicians. The University of Chicago FACE Card Program

9. Description: FACE CardsSide 1

10. Description: FACE CardsSide 2

11. FACE Card Procedure • During attending rounds for new patients, the team members place their card in the corresponding spot in the plastic card holder. • Team members give card holder to the patient and explain the project to the patient, asking him or her to rate the physicians.

12. FACE Card Procedure • FACE envelopes used for the collection of FACE cards are placed in patients’ charts in front of discharge papers by unit secretaries. • Reports for physicians are generated from completed evaluations. • Reports go into a portfolio for viewing by trainee during structured quarterly feedback session with PD or chief.

13. Sample Comments “This doctor made such an impression on me that I’m now going to switch her for my primary doctor. She was everything a successful, caring doctor should be…. I feel like I just found the most perfect doctor.” “Excellent young doctor. Very caring and sweet!” “While I believe this doctor cared for me excellently… most of the time I felt I was in the dark about what was happening. I never had a chance to ask questions until the end– mostly because everyone was always in such a hurry to get away.”

14. AAMC Survey: Curricular Content AAMC Medical Education’s Quiet Revolution

15. “I want the doctors of tomorrow to know that when all the formal teaching is over and I walk into your office my need is for medical care for my child, but my desperate hope is that you have the same stake in my child’s health as I do.” J. Schlucter Mother of 2 Both children with cystic fibrosis