Clinicians may also find themselves faced with patients who have more than one intermediate or complex decision to make. In these situations it is appropriate for the physician and patient to agree upon the highest priority discussion topic and focus their initial conversation on that. Further topics can be spread over other visits, as agreed upon by both physician and patient.
Clinicians who are involved in frequent intermediate and complex discussions with patients also may benefit from a systematic approach to these dialogues. The USPSTF suggests one possible approach “as:
û ASSESS
o the patient’s health needs (acute issues/eligibility for preventive services)
o the patient’s desired role in decision making
û ADVISE
o Inform the patient about recommended preventive service
o If time permits, inform the patient about other services with:
§ High visibility
§ Special individual importance
o If needed, provide balanced, evidence-based information about the service:
§ Benefits
§ Harms
§ Alternatives
§ Scientific uncertainties
o If appropriate make a recommendation
û AGREE
o Elicit patient’s values and determine preferences
o Negotiate a course of action
û ASSIST
o Deliver or prescribe service
û ARRANGE
o Follow-up or plan to revisit in the future”
This list breaks the dialogue down into its basic elements and incorporates most discussion points. The clinician will, of course, modify it as necessary to meet the needs of the situation; it specifies areas where the most frequent of changes are made. As in almost all situations, having a systematic approach to these conversations can help a clinician focus their approach and make sure that no elements are left out of the dialogue.
As in all other efforts to improve care and reduce liability, improving communication in this manner should include documentation of these conversations, especially those of intermediate and complex nature. It is also imperative that patient concerns be documented so that the record reflects key elements addressed in these interactions.
As each clinician reviews their practice for areas of risk and quality improvement, shared and informed decision-making processes should be enhanced or added to the daily routine of care. Ultimately these practices will improve communication and, therefore, your relationship with your patients; because you have improved these communications you have an opportunity to give better quality care; and ultimately you can reduce your liability because you have improved the quality of your care, improved your relationships with your patients, and improved the documentation of your interactions with them.
Changing communication patterns is not always easy. This article has given some basic steps and the reasons to implement them. If you, the clinician, find that you would like to know more about enhancing actual dialogues you may have with your patients, Princeton Insurance Company offers a Communication course to interested physicians and other practitioners. The course is available for varying lengths of time and offers CMEs or CEUs. Please contact Barbara Butler at 609-452-9404, x 5213.