Listening for What Matters: Avoiding Contextual Errors in Health Care

by Saul Weiner, Alan Schwartz

Overview

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.

Product Details

ISBN-13:	9780190229016
Publisher:	Oxford University Press
Publication date:	12/17/2015
Sold by:	Barnes & Noble
Format:	eBook
Pages:	272
File size:	2 MB

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.

Table of Contents

Introduction 1. Observing the Problem 2. Measuring the Problem 3. The Problem is Everywhere 4. What We Hear that Physicians Don't 5. Causes 6. Better Teaching, Better Doctors 7. Is Lasting Change Possible? 8. What We Can't Measure that Matters 9. Bringing Context Back into Care Notes Bibliography

Editorial Reviews

Reviewer: Jessica Ruth Ferraro, MHA (James A. Haley Veterans' Hospital)
Description: This book discusses failures of medical care that will continue to occur when physicians and other clinicians do not look at a patient's daily lifestyle when determining a treatment/care plan.
Purpose: The purpose is to examine the mistakes that have been made, and look at ways to better clinician care-planning skills. This is labeled "contextual thinking in healthcare." These are worthy objectives as this is a problem throughout all areas of healthcare.
Audience: This book is written for clinicians who are seeing patients on a daily basis. It also can be helpful for those supervising clinicians, as well as those teaching clinicians.
Features: The book is broken down into two major sections titled, "The Problem" and "Solutions." I enjoyed the chapters on measurement. At first, this does not seem like something that can be easily measured, but the book makes it clear that indeed it can be measured - it just takes a little thinking outside of the box.
Assessment: I enjoyed this book and hearing from those in the public sector. I look forward to seeing how this book and thinking resonates with clinicians and those teaching clinicians.

Doody's Review Service

"...people in the healthcare field, regulators, medical educators, and patients may find this an interesting and informative perspective of the patient-physician relationship." — Eileen M. Girten, AMWA Journal

"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

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"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

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