In aviation and medicine, safety first

INDIANA U. (US) — An essential piece missing from the health care puzzle is communication between doctor and patient, particularly when complex information is being relayed in stressful situations.

In spite of a strong endorsement over a decade ago by the 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 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.

The study appears in 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,” says Richard Frankel, professor of medicine at Indiana University.

“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.”

Likening medicine to aviation safety, Frankel says, “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,” Frankel says.

“Successful outcomes lie not simply in the mechanics of medical care, but in the social and emotional context of the doctor-patient relationship.”

Researchers from Michigan State University contributed to the study.

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