Training future doctors to enlist patients as partners in care

(Press-News.org) INDIANAPOLIS – With mounting evidence that patient-centered care improves medical outcomes, investigators from the Regenstrief Institute and Indiana University School of Medicine are providing a call to action for the training of future physicians to master relationship skills as well as the burgeoning scientific knowledge needed to practice 21st Century medicine.

"Crossing the Patient-Centered Divide: Transforming Health Care Quality Through Enhanced Faculty Development" appears in the April 2011 issue of the journal Academic Medicine.

"Medical education today is outstanding at teaching the biological domain, but patients and their families expect more of their physicians than to be diagnosed and sent on their way. They want to have meaningful discussions with their health-care providers," said Richard M. Frankel, Ph.D., Regenstrief Institute investigator and professor of medicine at the IU School of Medicine.

"We know that greater patient involvement in health care improves the quality of that care and lessens the number of medical errors. There is a growing body of evidence that good communication skills among health-care providers and between providers and patients lead to better outcomes," said Dr. Frankel.

What can be taught to help physicians partner with patients? Dr. Frankel and co-authors Thomas S. Inui, M.D., Regenstrief Institute investigator and professor of medicine at the IU School of Medicine, and Florence Eddins-Folensbee, M.D., of Baylor College of Medicine, propose three target areas.

Mindful practice — training medical students, faculty and practicing physicians to be more mindful of their own preconceptions, prejudices or other factors that may "slip through the door" into their interactions with patients. Also, since patient-centered care is person-to-person interaction, increased physician empathy and compassion and ability to convey these feelings should be encouraged. Formation — using the arts – poetry, music and movement – to help physicians stimulate self-awareness and remain in touch with their own values, hopes and dreams. Communication — improving the communication skills of physicians and other health professionals. According to the Institute of Medicine report, "To Err is Human," breakdowns in communication are the key cause in up to 80 percent of adverse medical events. Improved communication decreases the number of these mistakes.

A century ago the Flexner Report revolutionized medical education by focusing on mastery of biological and physical sciences. The standard of patient care in the 21st century goes far beyond these parameters and the authors call for medical education to catch up and even lead the way toward the future.

The authors write: "Given the increasing pressures on medical educators to cover more and more information in less time and the parallel challenge for practicing physicians of seeing more patients and having less time to do it, one might ask whether there is room in the (medical school) curriculum and whether we can afford the expense of teaching a whole range of additional patient and relationship-centered skills that integrate mind, body and spirit. We would ask, based on the best available evidence and consequences of what happens when patient and relationship-centered skills are absent, can we afford not to?"

### The IU School of Medicine and the Regenstrief Institute are located on the campus of Indiana University-Purdue University Indianapolis.