I recently purchased a book online called Putting Patients First–Field Guide by, Susan B. Frampton, Patrick A. Charmel and Susan Guastello. The book is unique in that it truly teaches (rather than tells) the reader through sharing global lessons regarding implementation of patient-centered care systems. This is the third edition of the Putting Patients First series. Dr. Susan Frampton is the president of Planetree, a nonprofit advocacy, consultation, and membership organization that works with a growing network of hospitals and continuing care communities around the world to implement Planetree’s person-centered model of care. Since I am not a clinician, I was skeptical about being able to navigate the vocabulary and understand the lessons learned. Far from it. I was walked through various prototypes hospitals have run in areas such as pediatric oncology, end of life care, later stage CHF, and routine check-ups. The prototypes are described, outcomes analyzed and discussed in the text.
One of my favorite topics (Chapter 4) is how to design training content for communicating with patients. As an example, there is a two-minute teaching technique to integrate communication training into teaching rounds. The first part of the example goes like this:
-Let the resident ask “what else?” three times. Share the example below (Barrier, 2003). Then have the resident ask “what else” three times at the next encounter.
This is a “physician-centered” conversation:
Physician: What brings you here today?
Patient: I have headaches.
Physician: Where are the headaches? How long do they last? What do you do to relieve them?
This is a “patient-centered” conversation:
Physician: What brings you here today?
Patient: I have headaches.
Physician: What else?
Patient: Well, I have problems sleeping.
Physician: What else?
Patient: I am very worried about my son. He is using drugs.
After I read these two scripts, I laughed out loud. Not because it was funny, but because the difference in quality of communication is so obvious through this example. The “what else?” question could help all of us, not just with our doctors, but in our personal lives communicating with our partners, children, family and friends. It is the art of having a conversation by asking open ended questions, rather than questions that search a specific answer. It’s a lesson I learned at Stanford when I was being trained how to conduct ethnography with strangers regarding a sensitive topic. It’s much harder to do in practice than one might think. Perhaps it’s because we feel uncomfortable talking about painful or highly personal topics, and want to fill the quiet space with words. Or perhaps we are in too much of a hurry to “fix” the initial complaint. The symptoms a person complains about often conceal a root of a bigger problem when we ask “what else?” Thank you for reminding me!
I would highly recommend this book for anyone interested in healthcare and patient-centered care standards. For designers in healthcare, it’s essential knowledge to understand the challenges clinicians and patients deal with on a day-to-day basis.