Mar. 7, 2011 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 Richard M. Frankel, 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 Richard L. Roudebush VA Medical Center. He is the senior author of the JGIM paper.
Dr. Frankel 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. Frankel. "Successful outcomes lie not simply in the mechanics of medical care, but in the social and emotional context of the doctor-patient relationship."
Dr. Frankel and co-authors Robert C. Smith, M.D., Francesca C. Dwamena, M.D., and John 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.
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