A medical home does not guarantee increased patient satisfaction

One of the more notable findings from the special report on the TransforMED National Medical Home Demonstration project was that “patient satisfaction doesn’t automatically go up.”

Terry McGeeney, CEO of TransforMED, attributed the lack of increased patient satisfaction experienced by the 18 participating physician practices to a variety of factors, chief of which “was the turmoil of change experienced by patients as practices implemented after-hours access, quick access to laboratory results and the chance to schedule e-visits or make a same-day appointment.”

But there is another likely cause for the less than stellar patient satisfaction results — the lack of effective physician-patient communications.

Don’t mistake activity for achievement

To be sure, patients in the TransforMED Medical Home Demonstration sites now have access to a myriad of new ways that patients could communicate with physicians – e-mail, telephone, web portals.

But there is no evidence in the TransforMED pilot of substantive efforts to improve the quality of the dialogue between physicians and patients. It is after all the quality of the physician-patient conversation — not the quantity of opportunities to communicate — that drive patient trust, behavior change, outcomes, and satisfaction.

McGeeney’s own comments allude to the long-standing problem physicians have communicating with patients. Physicians could have done a better job of “informing patients about what their practice was doing and why.”

The goal is patient-centered communication

Every physician conversation with patients ideally should begin from the patient’s perspective. As a physician, there are lots of things you want to say to your patients. The trick is how to say it in a way that individual patients will relate to and understand.

I am talking about more than health literacy. I am talking about understanding where the patient is coming from. This means understanding their living situation, their beliefs about their health, disease etiology, medication and the treatment you recommend … and couching what you have to say with that “patient context.”

I am talking about asking the patient what they want to accomplish during the office visit, asking about their “health story” and letting them finish without interruption.

Offering secure e-mail, web portals and access to their EMR will help with the physician-patient communication process. But unless the physician believes in patient-centered care and makes an effort to communicate in a more patient-centric fashion, the promise of the medical home will go unfulfilled.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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