Do Medical Home Physicians Really Communicate Any Better With Patients?

Probably not yet…

I thing everyone would agree that Group Health of Seattle probably has a pretty good “take” on issues dealing with primary care redesign and the Patient Centered Medical Home (PCMH).   That’s why I surprised by a recent comment on a Group Health blog from by Matt Handley, MD in response to an earlier post here about Patient Question-Asking.  Dr. Handley is an Associate Medical Director for Quality and Informatics at Group Health.

Dr. Handley writes:

“While doctors often take pride in how open they are to patient questions, our self assessment doesn’t match up very well with empirical evidence. A recent post on Mind the Gap summarizes a small study that is relatively terrifying to me – the take home is that doctors spend very little time explaining their recommendations, and that patients rarely ask questions. “

I picked up the phone and talked with Dr Handley about his comments and work being done on PCMH at Group Health.   Then it struck me.  If a medical home project on the scale of Group Health hadn’t substantively addressed improving the way physicians and patient communicate (i.e., encouraging patient question asking, etc.) what’s the likelihood that any other PCMH pilot would be addressing this problem?

The truth of the matter is that it does not seem that the problems of physician-patient communication are being substantively addressed (at least publicly) by any PCMH pilot. Nor are they addressed to any significant degree (beyond reference to having written standards and, recording the patient’s communication preference and having a web portal) by NCQA’s Medical Home Certification Criteria.

Yes Group Health has extended the length of the office visit from 15 minutes to 20 minutes.  Yes Group Health and many other PCMH pilots have implemented e-visits, along with electronic patient record technology.  Yes NCQA certification criteria requires written standards addressing patient “access and communications.”   But nowhere along the way have these initiatives taken steps to systematically improve the quality of the physician-patient dialog. As I cited in a previous post, simply increasing the length of the office visit will not automatically turn an otherwise autocratic physician into an empathetic, patient-centered communicator.   Physicians will need new tools, training and help from patients to become better communicators.

I think the Patient Center Medical Home, and its funding partner the Accountable Care Organization (ACO), hold great promise for both patients and physicians.   Like any innovation, their success or failure will rests on people’s ability to effectively communicate with one another.