Keeping the Patient in the Equation — Humanism and Health Care Reform

Hartzband, Pamela; Groopman, Jerome E.

doi:10.1056/nejmp0904813

Cited by 73 publications

(76 citation statements)

References 3 publications

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“…40 This failure to inform patients of clinically important results hinders a move away from the traditional paternalistic role of physicians towards a new model incorporating 'shared decision-making' in which the physician attempts to provide the patient and family with the full range of information, including laboratory results, about the clinical condition. 41 Further evidence of errors in reacting to laboratory information is given in a study on the prescription of potassium despite the presence of hyperkalemia. 42 Another study found that more than 2% (2.6% in 2000, 2.1% in 2007) of patients with thyrotropin (TSH) results higher than 20 mU/mL had no follow-up.…”

Section: Pre-and Post-analytical Phasesmentioning

confidence: 99%

The detection and prevention of errors in laboratory medicine

2009

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The last few decades have seen a significant decrease in the rates of analytical errors in clinical laboratories. Evidence demonstrates that pre-and post-analytical steps of the total testing process (TTP) are more error-prone than the analytical phase. Most errors are identified in pre-pre-analytic and post-post-analytic steps outside of the laboratory. In a patientcentred approach to the delivery of health-care services, there is the need to investigate, in the TTP, any possible defect that may have a negative impact on the patient. In the interests of patients, any direct or indirect negative consequence related to a laboratory test must be considered, irrespective of which step is involved and whether the error depends on a laboratory professional (e.g. calibration/testing error) or non-laboratory operator (e.g. inappropriate test request, error in patient identification and/or blood collection). Patient misidentification and problems communicating results, which affect the delivery of diagnostic services, are recognized as the main goals for quality improvement. International initiatives aim at improving these aspects. Grading laboratory errors on the basis of their seriousness should help identify priorities for quality improvement and encourage a focus on corrective/preventive actions. It is important to consider not only the actual patient harm sustained but also the potential worst-case outcome if such an error were to reoccur. The most important lessons we have learned are that system theory also applies to laboratory testing and that errors and injuries can be prevented by redesigning systems that render it difficult for all health-care professionals to make mistakes.

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Section: Pre-and Post-analytical Phasesmentioning

confidence: 99%

The detection and prevention of errors in laboratory medicine

2009

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“…The findings reported here also are meaningful for the process of shared decision making. Shared decision making is defined as the process ''in which the physician attempts to provide the patient and family with the full range of information about the clinical problem so that they can assess potential risks and benefits and make an informed decision about how to proceed'' [13]. Bozic and Chiu [5] reasonably predicted that such an approach could increase patient satisfaction for total joint arthroplasty.…”

Section: Utility Rxà Dxàmentioning

confidence: 99%

The Variability of Patient Preferences

Bernstein

2012

Clinical Orthopaedics &Amp; Related Research

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BackgroundWide variation in procedure utilization suggests that surgical indications might not be rigorously defined. An alternative explanation is that surgical outcomes are valued differently across groups. When a patient, using the information provided by the surgeon, places high value on successful results or is indifferent to the costs of ineffective treatment, the treatment threshold is lower and more surgery will be chosen.

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“…Clinical skills' training that is well organized and executed is one of the most important components of a modern medical curriculum. Despite marked improvements in medical education, in-hospital hands-on training remains the weakest point in many curricula (1)(2)(3)(4)(5)(6)(7)(8)(9). The "art of teaching" is still to be recognized as an important professional skill that needs to be properly mastered and permanently improved, alongside with clinical competencies and research activities.…”

Section: Wwwcmjhrmentioning

confidence: 99%

“…Young physicians-to-be have to touch, feel, hear, and smell the textbook stories and cases in a real world. This presents a serious problem, because during the last half-century, patients' way of thinking and their attitudes toward physicians have radically changed (7,20,21,25,32). Today, the common patient is not a humble, grateful, and obedient one.…”

Section: Portfolio (Logbook) Of Acquired Clinical Skillsmentioning

confidence: 99%

New Paradigm in Training of Undergraduate Clinical Skills: the NEPTUNE-CS project at the Split University School of Medicine

Šimunović¹,

Hozo²,

Rakić³

et al. 2010

Croat Med J

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Clinical skills' training is arguably the weakest point in medical schools' curriculum. This study briefly describes how we at the Split University School of Medicine cope with this problem. We consider that, over the last decades, a considerable advancement in teaching methodologies, tools, and assessment of students has been made. However, there are many unresolved issues, most notably: (i) the institutional value system, impeding the motivation of the teaching staff; (ii) lack of a strong mentoring system; (iii) organization, timing, and placement of training in the curriculum; (iv) lack of publications pertinent to training; and (v) unwillingness of patients to participate in student training. To improve the existing training models we suggest increased institutional awareness of obstacles, as well as willingness to develop mechanisms for increasing the motivation of faculty. It is necessary to introduce changes in the structure and timing of training and to complement it with a catalog, practicum, and portfolio of clinical skills. At Split University School of Medicine, we developed a new paradigm aimed to improve the teaching of clinical skills called "Neptune-CSS,

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Keeping the Patient in the Equation — Humanism and Health Care Reform

Cited by 73 publications

References 3 publications

The detection and prevention of errors in laboratory medicine

The detection and prevention of errors in laboratory medicine

The Variability of Patient Preferences

New Paradigm in Training of Undergraduate Clinical Skills: the NEPTUNE-CS project at the Split University School of Medicine

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