Doctor-Patient Relationship and Medical Professionalism

Holly J. Humphrey, MD

Dean for Medical Education

The University of Chicago Pritzker School of Medicine

Framing the IssueThe 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

ACGME Competencies

• Patient Care• Medical Knowledge• Practice-Based Learning and Improvement• Interpersonal and Communication Skills• Professionalism• Systems-Based Practice

ACGME Outcome Project, 1999

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

Etiquette Based MedicineChecklist for first meeting with a hospitalizedpatient:• 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

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

Example

The University of Chicago FACE Card Program

The University of Chicago FACE Card Program

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.

Description: FACE CardsSide 1

University of Chicago Hospital

General Medicine Service

Dr. Brian Callender

Medical Intern

Comments

Dr. Brian CallenderMedical Intern

Description: FACE CardsSide 2

Evaluation Key

Communication- How well did this person communicate with you and your family? Did they offer to answer your questions?

Compassion- Was this person sensitive to your and your family’s needs?

Respectfulness- Did this person ask and respect your choices about your care?

Responsibility- Did you feel this person acted appropriately on your behalf?

Rate from 0 to 100…

1. Communication

2. Compassion

3. Respectfulness

4. Responsibility

SCALE

100-Best Possible

90-Excellent

80-Very Good

70-Good

60-Above Average

50-Average

40-Below Average

30-Poor

20-Very Poor

10-Terrible

0-Worst Possible

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.

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.

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.”

AAMC Survey: Curricular Content

1980 2000

Communication 47% 80%

Geriatrics 82% 95%

Death/Dying 96%

Cultural Competence

70%

AAMC Medical Education’s Quiet Revolution

“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. SchlucterMother of 2Both children

with cystic fibrosis