It’s Not ‘Just One More Thing’

Jean Joseph, M.D., M.B.A.

Jean Joseph, M.D., M.B.A.

Transitioning to a patient- and family-centered care model may sound daunting, especially in light of physicians’ already-busy schedules. We spoke to Jean Joseph, M.D., M.B.A., professor of Urology and Oncology at URMC, to learn more about what the shift will entail for URMC faculty. Going forward, Joseph will be sending monthly communications to physicians to discuss how they can practice more patient- and family-centered care.

Pulse: Patient- and family-centered care sounds well and good, but let’s be honest – isn’t this initiative just “one more thing” we’re asking of already-busy physicians?

Joseph: It’s not “just one more thing.” It’s the thing. We cannot emphasize enough that this is not a campaign or even an initiative (though we might accidentally use those terms from time to time!). What we’re really talking about is culture change. It’s embracing the fact that the very reason we wake up and come to work each day is to care for patients and their families. Why wouldn’t we want to care for them in such a way that leaves them feeling empowered, confident and involved?

Pulse: True. But I imagine culture change is a slow process? This isn’t something that will happen overnight.

Joseph: Anytime we adjust to new ways of working, it takes time. But what we need to realize is that many of us, in one way or another, are probably already delivering a patient- and family-centered care experience to some degree. We just need to do it more and more, and to do it better. We need to more consistently “put on the patient’s glasses” and ask what we would want if the roles were reversed. After all, at some point, each of us will be a patient.

Pulse: What are patients telling us they want?

Joseph: I think they primarily want two things: to have their thoughts heard and respected, and to be involved in their own care. It’s no secret that a white coat can be intimidating, so some patients may need a bit of coaxing to offer their input. We’ll need to make them feel comfortable to voice their preferences or concern. Still, others will have no trouble speaking up.

We also need to appreciate that fact that patients and families can offer unique, valuable, sometimes even life-saving insight – how they feel, if a loved one is behaving funny, or even if there’s a pill in their medication regimen that they don’t recognize. If we listen, these insights can dramatically improve our decision-making.

Let me give an example. I once performed surgery on a young woman and, upon talking with her further, learned that she was a single mother to four children and had little in the way of a support network. Sensing her apprehension about returning home, we postponed her discharge by a day. Her recovery was more successful thanks to that extra day; it ensured that she felt strong enough to return to her little ones.

Pulse: Aside from more satisfied patients, what do we stand to gain as physicians?

Joseph: More satisfaction ourselves! The truth is, when we create happy patients, our careers are more gratifying. The cycle goes round and round.  

Health care, unfortunately, has become so transactional. A patient needs care or an intervention, we perform it, end of story. But when we practice patient- and family-centered care, health care returns to what it was always meant to me: a mutually rewarding relationship.

Let me give another example. Over the years, I’ve made a habit to call patients the evening before I perform their surgery. Selfishly, I want to ask how they are doing because their response helps me know what to anticipate the next morning (in many cases it has been weeks since I’ve last seen them in my office). What’s remarkable is that the patients seem to get more out of the call than I do. The mere fact that I called – perhaps more than anything that we discussed – puts them at ease and assures them that I’m in control of the situation. In this small way, I’ve started caring for them before they even set foot in the door.

Pulse: This sounds like the right way to practice medicine. But it’s such a sweeping change!

Joseph: You’re right – this is a sea change. It must seep into every part of our health care system. It must be embraced by every team member, from the patient transporter, to the physician, to the nurse, to the unit secretary. Everyone.

That said, we can’t let this become so daunting that we don’t act. The timing will never be perfect. We’ll always have things to overcome, like crowded parking garages, or the occasional bad day or short fuse. But we need to refocus and try again. Again, this is a journey. While we can’t control a patient’s entire experience, we each control a piece. And if we each focus on making our piece a “wow” experience, we’ll be moving in the right direction.

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