Quality medical care should include a patient-centered approach

Mar 13 2006

A study of Mayo Clinic patients has found seven behaviors define the 'ideal' physician and supports an Institute of Medicine recommendation that quality medical care should include a patient-centered approach.

The Mayo Clinic-led study was designed to develop a comprehensive set of ideal physician behaviors. Telephone interviews were conducted in 2001 and 2002 with 192 patients who were seen in 14 medical specialties of Mayo Clinic in Scottsdale, Ariz., and Rochester.

Published in the March issue of Mayo Clinic Proceedings, the article was based on transcripts of patients detailing their best and worst experiences with a Mayo Clinic physician. From the transcripts, study authors identified seven behaviors that describe the ideal physician - confident, empathetic, humane, personal, forthright, respectful and thorough.

Conversely, patients who described a "worst physician" experience focused on traits reflecting opposites of desired physician behaviors, especially perceived insensitive or disrespectful behavior.

The study suggests that training new and practicing physicians about interpersonal skills could have far-reaching effects for patients. The quality of a patient's relationship with a physician can affect not only a patient's emotional responses, but also behavioral and medical outcomes such as compliance and recovery.

An editorial in the same issue expands on the patient-physician relationship, saying health institutions ought to follow the recommendations of the Institute of Medicine to improve quality by fostering a patient-centeredness approach to medicine.

James Li, M.D., Ph.D., Mayo Clinic Division of Allergic Diseases, writes in an editorial that health care can't meet a standard of quality if the patient-physician interaction is hurried, disrespectful, cold or callous. Dr. Li has been involved with developing programs and curricula for teaching new and practicing physicians at Mayo Clinic about how to strengthen their interactions with patients. Mayo's structure of focusing on the patient also helps nurture strong relationships between physician and patient, he says.

"A physician who pays personal attention to the patient, who is respectful, compassionate and competent, that's what every patient wants," Dr. Li says. "It's really the duty and obligation of the medical community to design a health care system so that physicians are best able to exhibit those qualities for the good of the patient during the clinical encounter."

Dr. Li notes the seven behavioral traits identified by researchers as ideal for physicians can be taught in various settings, such as having medical residents witness positive interactions which they can model.

Of the seven behavior traits, "thorough" was named most often by patients. Patients can sense if a physician is rushed or preoccupied, the study's authors say, just as they can sense a physician's genuine interest.

"If patients have opportunities to tell their stories, to be asked questions and have the physician verbalize understanding of what's been shared, it leaves them feeling like they were heard," Dr. Li says. "This leaves them with the impression that the physician was thorough." In their interviews about physician behavior, patients rarely commented on a physician's technical skill. This doesn't suggest technical skill is less important than interpersonal skill, the authors say, but rather more difficult for patients to judge.

Authors of the study include Neeli Bendapudi, Ph.D., Fisher College of Business, Ohio State University; Leonard Berry, Ph.D., from the Mays Business School, TAMU System Health Science Center, Texas A&M University; Keith Frey, M.D., Department of Family Medicine, Mayo Clinic in Scottsdale; Janet Turner Parish, Ph.D., Mays Business School, Texas A&M University; and William Rayburn, M.D., Department of Obstetrics and Gynecology, Texas A&M University Health Science Center and Scott & White Clinic.