Teaching Bedside Manner
http://thekojonnamdishow.org/shows/2011-10-13/teaching-bedside-manner
From a paternalistic "doctor knows best" attitude to what's known as patient-centered care, doctor-patient relations have been evolving for decades. But many patients today feel that despite this evolution, they don't get enough time with doctors and are left to manage their own care with little guidance. Kojo explores medical training programs and patient advocacy groups aimed at improving the doctor-patient relationship.
Guests
Mark Siegler
Lindy Bergman Distinguished Service Professor of Medicine and Surgery; Executive Director, Bucksbaum Institute for Clinical Excellence; Director, MacLean Center for Clinical Medical Ethics
Santi Bhagat
Patient advocate
Rhonda Wyskiel
Registered Nurse, ICU, Johns Hopkins Hospital; Senior Research Coordinator,Armstrong Institute for Patient Safety and Quality
Comments
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Kojo:
As you know I am an anthropologist and part of what I do is train physicians in the cultural aspects of the beliefs and customs of patients. With the increase of immigrants into the U.S., physicians' training will have to have an anthropological component or they will be responsible for what is called "iatrogenic" or doctor-originating serious adverse events.
Kathleen Rand Reed
Patient care in the U.S. is completely fragmented into a web of specialists, almost none of whom coordinate with a patient's other doctors or bother to contact the patient following treatment. Our dog's veterinary practice always calls to see how their patient is faring. My daughter's many specialists NEVER call after the office visit.
Care in the U.S. is insurance company-centered, and practice-centered, not patient-centered. My daughter was bitten by a tick at age 7. Five years later, she was finally diagnosed with Lyme Disease, Babesiosis, and Bartonella. Subsequently she was homebound from age 12 to 18. The insurance industry labelled her condition post lyme syndrome and offered no guidance to her care, other than to deny payment for the treatment that ultimately got her out of bed and functional -- that is, long term IV and oral antibiotic treatment.
We have gold-plated insurance coverage, which offered case management -- but in our case, the insurance case managers were completely uneducated about Lyme Disease. Since the medical establishment denies the existence of chronic lyme, how can they "manage" it?
Two years ago, I finally took my daughter to a lyme literate specialist -- who cannot take insurance since insurance companies disallow long term antibiotic treatement -- and paid $25,000 for her successful treatment (which is ongoing).
And by the way, it was a primary care physician who diagnosed my daughter, not any of the myriad of specialists who saw her along her journey.
Brenda Shelonko
Dear Kojo,
A previous caller mentioned that during her treatment at Johns Hopkins she felt as though she had coordinate the care she was receiving from excellent specialists.
I have also had several experiences where I've felt lost between different specialists - and recently found a primary care doctor who has does a great job overseeing the treatments prescribed by each specialist - and making sure that I am cared for as a whole person.
However, this is a lot of work for my primary care doctor - and he is not compensated on the same level as a specialized surgeon.
How do we move toward a patient centered system if primary care doctors are not valued or allowed to have sufficient time with patients?
Thanks!
Mayo Clinic is an institution that really works to have patient-centered care. The mission statement of the facility is "the needs of the patient come first." The book "Management Lessons from Mayo Clinic" provides a really interesting read (despite the title) about how the Clinic has worked for 100 years to provide excellent service to its patients from all over the world.