Keywords: Clinician-patient communication, shared decision making, medical mistakes, e-patients.
Citation: Graedon J, Graedon T. Putting patients on the health care team. J Participat Med. 2013 Aug 21; 5:e34.
Published: August 21, 2013.
Competing Interests: The authors have declared that no competing interests exist.
Teamwork is the buzzword in health care today. There is a growing recognition that patient safety requires doctors, nurses and everyone else who comes into contact with patients to work together.
Far too frequently, though, the patient and his family are left out of the equation. Health professionals have been trained to believe that they alone are responsible for diagnosing, prescribing, and caring for patients, who are supposed to follow orders obediently.
This is a missed opportunity. The airline industry offers us a magnificent model for how teamwork can save lives. In the old system, the captain was king and no one ever questioned his command. No matter how dicey the situation, the co-pilot and other crew were expected to follow orders without comment.
After one too many crashes, though, the industry retooled this model. Now, airline crews are trained to work in teams and all members are valued and expected to speak up. This has worked extremely well to prevent crashes until a recent flight from South Korea to San Francisco. Although the final report has not been written, preliminary accounts suggest that there was a breakdown in cockpit communication, which may have contributed to the disastrous crash.
Hundreds of thousands of patients die each year because of health care mistakes: misdiagnoses, medication errors, hospital-acquired infections, adverse drug events, and surgical complications. Many of these problems could be prevented with better communication and a teamwork approach, especially if patients and their families were treated like members of the team.
What would this be like? Although health professionals like to think that diagnosis is solely their bailiwick, a recent analysis suggests that there are 80,000 to 160,000 cases of death or disability due to diagnostic errors annually in the US. To help reduce this problem, patients and their families could be encouraged to go online and use the symptom checker from Isabel.
Because patients and their families have the time, motivation, and intimate knowledge of the individual’s symptoms, they will be able to use this tool to get an initial list of possible diagnoses that they can supply to their health care providers to improve the likelihood of an accurate diagnosis.
The co-pilot used to be thought of merely as a backup in case the pilot became incapacitated during flight. Now, however, it is clear that the co-pilot is actively involved in all aspects of the flight and is a full member of the team. In just such a manner, the patient and her family need to be actively involved in monitoring, implementation, and followup of any care plan. That includes medication review, dietary modification, exercise regimens, and data collection (blood pressure, blood sugar, weight, etc).
For these important tasks to be carried out successfully, though, the health care hierarchy will need reorganization. Physicians will need to go beyond their current practice of soliciting input from other providers, such as nurses, respiratory therapists, and pharmacists. They will also need to actively welcome the patient and family onto the health care team as equals. This will allow for shared decision making in a collegial atmosphere and will increase patient satisfaction, reduce errors and improve the likelihood of optimal outcomes.
- Saber Tehrani AS, Lee H, Mathews SC, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank. BMJ Qual. Saf. 2013; 22:672-680. ↩
- Landro L. A better online diagnosis before the doctor visit. Wall Street Journal. July 22, 2013. ↩
Copyright: © 2013 Joe Graedon and Terry Graedon. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.