What doctors (and patients) can learn from air traffic controllers: What's that

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What doctors (and patients) can learn from air traffic controllers: What's that

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http://www.eurekalert.org/pub_releases/2011-03/iuso-wd030711.php

INDIANAPOLIS – A review of 35 years of scientific medical studies confirms that

the social and emotional context of the doctor–patient relationship have yet to

be incorporated into the equation when it comes to health care.

In spite of its strong endorsement over a decade ago by the influential

Institute of Medicine report, " Crossing the Quality Chasm: A New Health System

for the 21st Century, " which highlighted the benefits of care that is respectful

of and responsive to patients' needs, values and concerns, patient-centered

medicine has not become part of the mainstream.

A review of the medical literature from 1975 to April 2010 found that less than

one percent of the 327,219 randomized controlled studies published in

peer-reviewed journals over the past 35 years included patient-centered care

trials. " Behaviorally–Defined Patient-Centered Communication – A Narrative

Review " appears in the February 2011 issue of the Journal of General Internal

Medicine

" We are only at the water's edge in terms of availability of patient-centered

care studies because they aren't being done. We need to encourage researchers to

implement clinical trials that evaluate care that focuses on communication

between physician and patient. Ultimately, we need processes that have been

tested and proven, " said M. el, Ph.D., Regenstrief Institute

investigator, professor of medicine at the IU School of Medicine, and a senior

scientist in the Veterans Affairs Center of Excellence for Implementing

Evidence-Based Practice at the L. Roudebush VA Medical Center. He is the

senior author of the JGIM paper.

Dr. el uses an analogy from aviation where safety is given the highest

priority. " When the air traffic controller gives an instruction to the pilot,

the pilot's response must be phrased to indicate understanding of the air

traffic controller's message. We don't have that in medicine. The doctor speaks

to the patient and generally does not solicit a response that clearly indicates

the patient understood what the doctor wished to convey. "

As with the cockpit and control tower exchange, the exchange at the hospital

bedside or in the doctor's office requires communication of complex information

in stressful circumstances. In both aviation and medicine, good communication is

critical to safety.

" What we have found repeatedly is that medical care succeeds when there are

stable and enduring relationships, " said Dr. el. " Successful outcomes lie

not simply in the mechanics of medical care, but in the social and emotional

context of the doctor-patient relationship. "

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Dr. el and co-authors C. , M.D., Francesca C. Dwamena, M.D.,

and Coffey. M.D., of Michigan State University, and Madhusudan Grover,

M.D., of the Mayo Clinic, note that in spite of paucity of randomized control

trials incorporating patient-centered care, indirect evidence of its

effectiveness continues to be compiled.

The IU School of Medicine and the Regenstrief Institute are located on the

campus of Indiana University-Purdue University Indianapolis.