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Effective health care requires physicians tailor care to patients' individual life contexts, including their financial situation, social support, competing responsibilities, and cognitive abilities. Physicians, however, are poorly prepared to consider patients' lives when planning their care. The result is measurably harmful to individuals and costly to society.
Listening for What Matters: Avoiding Contextual Errors in Health Care covers ten years of empirical research based on hundreds of recorded doctor visits by patients and undercover actors alike, which revealed a widespread disregard of patients' individual circumstances and needs resulting in inappropriate care. These medical errors have been largely undocumented and unaddressed by the American healthcare system.
This book tells the stories of patients whose care was compromised by inattention to individual context, and introduces novel methods for assessing the magnitude of the problem. It describes how these errors, termed "contextual errors," can be minimized through changes in how doctors are trained, how medicine is practiced and quality measured, and in the ways patients assert their needs during visits. The aim of this book is to open a dialog between patients, physicians, policy makers, and medical educators, about a serious quality problem that has been overlooked and understudied.
- Sales Rank: #606460 in Books
- Published on: 2016-01-18
- Released on: 2016-02-11
- Original language: English
- Number of items: 1
- Dimensions: 6.10" h x .70" w x 9.10" l, .0 pounds
- Binding: Paperback
- 240 pages
Review
"In today's health-care-obsessed culture, Listening For What Matters is an absolute must read. ... Listening For What Matters ... is a truly unique and important book with a broad-brush reach: Consumers should read it to learn how to better communicate with their healthcare providers, while doctors should immediately review the Weiner-Schwartz "4C" guide-posts to learn how to hear what their patients just said." --Electric Review
"I encourage every physician from all disciplines to read this important book, Listening for What Matters: Avoiding Contextual Errors in Health Care." --Jathan & Heather
Featured on mental_floss.
Featured on Patient Safety Network
Featured on The Student Doctor Network: Physician Features.
Featured on Huffpost Healthy Living Blog
"The concept of patient-centered medical care, originally a call for clinicians to attend to the psychosocial as well as biomedical needs particular to each patient, has since been co-opted as a marketing tool by the commercial enterprise that is American medicine. A 'patient-centered' practice now boasts evening hours and a good web site--but may or may not be attentive to the issues so critical to clinical practice that Weiner and Schwartz explore here. Their work on contextualized care reclaims this territory and redefines what it means to be patient-centered, with a robust and pragmatic model useful in teaching, practice, and in further research on physician behavior." --Raymond Curry, MD, FACP, Senior Associate Dean for Educational Affairs, University of Illinois College of Medicine, Charter Member, American Academy on Communication in Health Care
"Weiner and Schwartz take you behind the scenes in failed and successful patient/doctor interactions, as well as clinical trials and medical education classrooms. In the process, they illuminate the reasons for successful and unsuccessful patient/doctor interactions. This is a book that should be read by all patients who want to get the most from their interactions with their physicians. This is a book that should be read by all medical students, physicians, health care executives, and policy workers. There is something for everyone. This is a highly readable exploration of the patient/doctor relationship and how all involved parties can improve it." --Walter J McDonald MD, MACP, Emeritus CEO American College of Physicians
"This book should be required reading for anyone teaching medical students and residents. This groundbreaking book has the potential to incite a revolution in graduate medical education. The writers have scientifically demonstrated that many physicians are not skilled at interviewing patients with complex medical as well as psychosocial issues. We ignore the information shared in this valuable book at our own peril." --Michael R. Wasserman, M.D., Director, Nursing Home QIN-QIO, Health Services Advisory Group, Inc.
"This fascinating story summarizes decades of research by its authors, Dr. Saul J. Weiner and Dr. Alan Schwartz, into the importance of the 'patient's context' in prescribing care. Physicians who apply guidelines based on biomedical criteria without modification to fit the situational, demographic, cultural, and social dimensions of the individual patient are at risk of a serious medical error: prescribing 'the right treatment' to the 'wrong patient.' The book makes an important contribution to an understanding of the requirements for patient-centered care, one that emphasizes the importance of physician as well as patient engagement in diagnosing context and sorting out the treatments that the individual patient wants and needs." --John E. Wennberg, Peggy Y. Thomson Professor Emeritus, Evaluative Clinical Sciences & Founder, Director Emeritus of The Dartmouth Institute for Health Policy and Clinical Practice
About the Author
Saul Weiner, MD, and Alan Schwartz, PhD, at Jesse Brown VA Medical Center and the University of Illinois at Chicago College of Medicine, have spent the last ten years studying how well physicians personalize care to their patients. Their work involving undercover actors and audio recording by real patients carrying concealed audio recorders has been published in Annals of Internal Medicine, JAMA - The Journal of the American Medical Association, BMJ Quality & Safety, The Joint Commission Journal of Quality and Patient Safety, and Medical Decision Making. They are also the founders and principals of the Institute for Practice and Provider Performance Improvement, Inc., which brings these techniques from research into practice.
Most helpful customer reviews
2 of 2 people found the following review helpful.
This book grounds its intellectual innovation with a deep and compelling understanding of what it means to help others.
By waterbuck2
Listening for What Matters profiles a decade of work to identify and begin fixing a serious problem: doctors often propose the wrong treatments for their patients, not because they have the science wrong, but because they fail to understand that what is right for one patient may not be right for another. Extraordinarily, it’s based on over a thousand covertly recorded doctor-patient encounters. This is a book that gracefully ties research rigor with a deep understanding of human suffering. It offers copious insights not just to health professionals but to members of the lay public who ask themselves (as I do) “Why do my doctor’s visits so often seem to involve fruitless exchanges of information without fixing anything?”
To understand the problem, consider this story from one of the early chapters:
A woman with kidney failure keeps getting admitted to the hospital because she has missed her outpatient dialysis appointments repeatedly. The chart says she is “noncompliant” with care. She is told, each time, that it’s critical she not miss her dialysis anymore. As Weiner and Schwartz detail, no one asked her the obvious question: “Why do you keep missing your appointments?” It turned out the patient had her dialysis at an outlying clinic while the grandson under her care required specialty services every week at a teaching hospital. Moved her dialysis to the same hospital and boom: problem solved.
As the authors have it, doctors are educated and trained in ways that leave them routinely unable to see when to ask what would seem to be blindingly obvious questions in which a modest level of engagement and curiosity could prevent wasted time, wasted resources, and lead to a patient who actually gets better.
This is a book where the authors lay out what they have learned from over a decade of federally-funded research, including both Veterans Affairs hospitals and private academic medical practices. They explain the problem in brief, compelling narrative.
They lay out their creative series of experiments to illustrate how frequently doctors overlook obvious life challenges patients face (“contextual red flags”), and then send them out with a care plan that is doomed to fail. They did it by audio-recording doctor’s visits (with the doctors’ permission), first with trained actors (secret shoppers) and then with real patients carrying covert recorders. They show this problem to be prevalent, that the skills involved in “contextualizing care” are teachable, and that physicians (for the most part) like learning about it. They also let readers see up close and personal just how as a team they navigated extraordinary challenges that encumber the bureaucracies of both research and quality improvement.
The authors make abundantly clear that this is NOT yet another book on making doctors more humanistic, caring or compassionate. Rather it’s the story of how doctors either notice or fail to notice and explore information that actually matters to whether the patient is offered the wrong plan or the right one.
But they are also clear that their methodology focuses on a set of teachable behaviors that are ultimately easiest to learn for the professional who begins by seeing patients as fellow human beings, neither looking down on them nor putting them on a pedestal. Engagement emerges from respect for patients. The work of engagement, in their research, actually did not add extra time to clinical visits. In fact, it prevented wasted time due to offering treatments that were wrong in the first place.
What glues this book together are four things that make it particularly compelling. First, the authors make the human problem clear from the start and they know how to name and describe the shortfalls that afflict medical care in a way that is entertaining at times, and often touching. When the authors describe the gentle exploration that revealed how a fear of needles from a prior history of abuse led a dental patient to seek antibiotics and not a dentist for a rotten tooth, it’s palpably emotional for the reader. Moments like that recur throughout the book.
Second they convey ingenious research designs with utterly clear language, in a book that is reasonably short. This is not a hard book to read.
Third, they show from their own research that the problem they study is addressable.
Fourth, what makes this book inspirational is that it is infused with a coherent, commonsense ethical respect for patients, and for doctors as people who can and should recognize that the cookbook quality metrics of today’s health care should never get in the way of actually helping patients get better. Chapter 8, titled “What We Cannot Measure,” describes what it truly means to respect and help a fellow human being while maintaining one’s own boundaries. It should be required for any health care provider.
The ideas in this book demand a paradigm shift in what it means to make the right medical decisions for patients. The authors go way beyond describing “what ails medicine” or proposing marginal refinements to how quality is enforced by payers.
This work takes the discussion of health care back to its original purpose: professionals need to help real patients with real problems. Our methods of teaching medicine and enforcing quality sometimes unintentionally cripple that worthy objective.
But the problem can be observed, measured, and remediated using the methods this team developed. This book grounds its intellectual innovation with a deep and compelling understanding of what it means to help others. As a health services researcher, I can state that it offers some of the most innovative thinking on improving health care I have ever seen.
0 of 0 people found the following review helpful.
Great read on patient-centered care and innovative research methods
By Paula Blasi
"Listening for What Matters" shows that high-quality health care involves more than following clinical guidelines. It involves being sensitive to a patient's life circumstances, and incorporating that context into a care plan. In this book, Saul J. Weiner and Alan Schwartz describe 10 years of research on the importance of contextualized care. Often their methods are as interesting as their findings. The authors used trained actors posing as patients to explore how often physicians pick up on contextual factors, and they recruited real patients to covertly audio record their visits (all with physician consent). They also designed and tested a mini-curriculum for medical students, as well as a quality improvement project at two Veterans Health Administration medical centers. While describing the highs and lows of their research efforts, the authors weave in vivid stories about real physician-patient encounters and missed opportunities for contextualized care. This book is a great read for clinicians, researchers, patients, and anyone with an interest in advancing patient-centered care.
--Paula Blasi, Group Health Research Institute
0 of 0 people found the following review helpful.
A must read for health care providers, medical educators and administrators !
By Nicholas F Furtado
Saul and Alan have added an important and often unseen domain to patient centered clinical decision making. Their work shows that contextualization of medical decisions is key to successful individualization of patient care plans.
This book also describes how their passion for this research provided the impetus to prevail over difficult technical and administrative obstacles the details of which are useful for prospective researchers of medical contextual error.
Illuminating gaps in contextualization of clinical decisions through the framework of 4C can yield much " low hanging fruit” for QI and should be a routine part of systematic supply side initiatives to improve patient care in the future. This book is an essential read for all committed health care providers.
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