Listening Beyond Auscultating: A Quality Initiative to Improve Communication Scores in the Hospital Consumer Assessment of Health Care Practitioners and Systems Survey

Abstract

Medical students used established improvement methods to promote patient-centered care and align patient and physician agendas, providing a strategy to improve hospitalized patients' perceptions of physician listening.

Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter

“…your main question or concern for today?" [49][50][51][52] The clinician should then incorporate the patient's priorities into the visit agenda (eg, "I want to make sure we are on the same page about what you want to cover today"). 39,43,48,53 Toward the end of the visit, asking "Is there something else you want to address in the visit today?"…”

“…(rather than asking "Is there anything else …") can also reduce the number of unmet concerns and does not meaningfully increase visit length. 54 Eliciting patient concerns can increase the amount of condition-related information that physicians receive [50][51][52][54][55][56][57] and improve patients' perceptions of a physician. 49 Implementation of this practice may vary by context; for example, in clinics that conduct previsit questionnaires, a patient's responses can form the basis for a discussion about visit priorities.…”

Creating opportunities for patient participation in managing medications across transitions of care through formal and informal modes of communication

“…Prompts about older patients' medication management under eMARs encouraged pharmacists to initiate informal discussions with the patients with the purpose of examining their existing nonadherence or to confirm their preferences for managing medications following discharge. These observations built on Riegels et al's 30 findings emphasizing that structured reminders embedded in electronic records actually helped physicians to initiate individualized conversations with the patients on ward rounds by encouraging them to talk about their concerns about their discharge plans and treatment regimens. 30 Most of these prompts were created to meet institutional requirements to facilitate formal interactions amongst health professionals, but the ones that were created with inclusive language such as ‘Discuss outcomes with son’ or ‘Assess closer to discharge if patient happy to continue self‐management’ acted as directives for pharmacists to involve older patients or family members in decision‐making processes.…”

“…These observations built on Riegels et al's 30 findings emphasizing that structured reminders embedded in electronic records actually helped physicians to initiate individualized conversations with the patients on ward rounds by encouraging them to talk about their concerns about their discharge plans and treatment regimens. 30 Most of these prompts were created to meet institutional requirements to facilitate formal interactions amongst health professionals, but the ones that were created with inclusive language such as 'Discuss outcomes with son' or 'Assess closer to discharge if patient happy to continue self-management' acted as directives for pharmacists to involve older patients or family members in decision-making processes. Even though these notes promoted the informal communication between pharmacists and older patients or their family members, a multidisciplinary effort is needed to maximize the benefit of utilizing electronic records when communicating with older patients about their medications.…”

Listening to your patient, a key factor for successful consultations in a clinical setting

“…4 Recalling the background of a new patient and knowing their setting encourages a dynamic 360 O review and helps to place the illness in context. 5 Given the opportunity to talk, without interruption, patients have a longer opportunity to give complete histories. Organ systems are natural to discuss.…”