The Collaborative Approach to Patients (CAP)

Several recent events make this a good time for me to start posting intermittently on what I see as the collaborative approach to patient care.

During my thirty years as a primary care physician (and for some years before that, listening to and observing my father) I have seen the practice of medicine move ever further from the old, rigidly patriarchal approach to a far healthier patient-centric and more collaborative approach. The process, or at least my appreciation of it, has been uneven and far from painless. It is also a work in progress. Since cultures and societies must evolve (or collapse), I see this as a process where ‘complete’ is not an option.

I have been a member of the Society for Participatory Medicine for a while. Until recently I was mostly a lurker on their ListServ, forums, and blog. Lately I have found the conversations there compelling in their focus on relationships among the participants in health care. If you work in health care, you should join. If you don't work in health care but think you might ever be a patient, you should join.

Meanwhile, my local institution has embarked on a journey of improvement. One of the tools they have chosen to use is NRC Picker’s patient satisfaction survey process, aimed at measuring the quality of the patient experience (as reported by the patient) and identifying what needs to be improved (from the perspective of the patient). This involves different metrics, different targets, different processes and a different mindset from the improvement initiatives more familiar to clinicians, which are mostly based on clinical process and outcome measures. This patient-centric improvement process tends to evoke a pretty negative response from clinicians, which is a shame. It is also irrational and counter-productive. What does one expect to happen to a retail or service business that says the experience, needs and opinions of its customers are irrelevant?

OI will periodically be posting some thoughts, experiences, links and questions about the following:

  • What are some commonalities or differences among patriarchal, participatory and collaborative approaches?  What are the implications? Is there a good-evil spectrum? 
  • Philosophical premises and arguments for the use of a collaborative approach to patient care.
  • Psychological, behavioral, sociological information related to the need for, benefits or harms of, and appropriate/inappropriate use of collaborative models.
  • Anecdotes and examples from my clinical practice to illustrate points, using archetypes of patients and providers.
  • Problems, and hopeful solutions.
  • When engineering change, what things work and what things don’t.

This is a tentative roadmap and there is no syllabus or firm posting schedule.  I reserve the right to take detours or change the itinerary as I go. Please feel free to join me on this journey, share in my discovery process, and contribute feedback and suggestions.



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