I just heard a nice presentation by Dr. Garth Graham from HHS Office of Minority Health. He described the continuing disparities in outcomes over the past 20 years, noting specially the worsening disparities for poor people in the last 5-8 years (with data not yet accounting for the economic disaster).
I found it very interesting and no surprise that poor people are three times as likely to report difficulty communicating with their health providers than non-poor people. Dr. Graham made the point repeatedly that health care starts with interaction and communication and provided several anecdotes of the best interventions going nowhere because the patient and or caregiver didn't understand.
I recall a presentation by Dr. David Sobel of the Permanente Medical Group: listening to our patients, understanding their needs and wants and coming to a joint understanding of how they might include our advice and recommendations in their lives has a more profound effect on health outcomes than any pill or other intervention at our disposal.
We must move past lip service ("we have always been patient-centered!") and self-congratulatory delusion ("Of course we know what patients want and need."). We do this when we ask our patients about their wants and needs, when figure out with them how to honor both their desire to live well and long and our desire to help them with the latest and best medical knowledge and interventions.
It starts when we routinely and reliably ask about and address patient and caregiver wants and needs, when we improve our ability to communicate and collaborate.
How will we know that we're doing a good job at this? We must ask our patients. The mark of success is "percent of patients who agree that they understand their condition" and "percent of patients with conditions who say that they are confident in self management."
Gordon
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