Joining forces for patient safety

For all the high-level discussion on how to improve patient safety, a vitally important dialogue is the one that takes place in the exam room between a physician and a patient.

The words "patient safety" likely won't be mentioned. But an exchange marked by openness and understanding between a patient and a physician can have a major impact on the quality and outcome of treatment.

A sense of shared responsibility between a patient and physician about care can improve the level of communication, creating a sense of mutual relationship and trust, and firming the bond between physician and patient as partners in care. To underscore physicians' commitment to seeking this partnership, the American Medical Association has joined with AARP to create a Web resource that outlines the parameters for an effective physician-patient relationship. The resources outline exactly what the physician needs from the patient, and what the patient needs from the physician, to work together for the best diagnoses and outcomes.

The AMA-AARP partnership includes links to various resources from both organizations about patient safety. But the centerpiece is a direct declaration of patient and physician responsibilities, with a set of paired promises from each side.

The promises cover communication, shared decision-making and patient-physician partnership. For example, to improve communication, the patient promises, "I will talk about my health openly with my physician." Concurrently, the physician promises, "I will listen to my patients respectfully and honor their confidentiality."

As an example of emphasizing shared decision-making, the patient promises, "I will work with my doctor to choose medical treatments that are right for me." The physician promises, "I will explain medical options to my patients and help them choose high-quality, safe treatment plans."

To cement the partnership, the patient promises, "I will do my best to follow my treatment plan and manage my own health care." The doctor promises, "I will monitor my patients' health and their ability to safely manage their own care."

That there is a patient-physician partnership has long been an underpinning of physicians' code of ethics. But the AMA-AARP effort is part of a movement to make clear to patients that physicians want them to be active in their own care, and that what they get from their doctors reflects their goals and the physicians' intent. That way, care is optimized -- and so is patient safety.

Improving communication as a means of improving patient safety isn't just about the exam room. The AMA, through its Making Strides in Safety program, also has resources online that explain how to improve communication throughout the continuum of care, such as between physicians and hospital staff, administrators, other physicians and anyone else involved in a patient's care.

But what the AMA-AARP collaboration does is tell patients that their input is necessary and welcome. This isn't a demand that every patient aggressively partner with his or her physician. Instead, it's an invitation to discussion. The idea is that instead of talking about patient compliance with a physician's plans, the discussion will be about patient adherence to a course of treatment that comes as a result of a trusting relationship with a physician.

These discussions can seem pretty basic compared with high-level talk by leaders in medicine about how to improve patient safety. But those one-on-one discussions in the exam room can be just as essential to advance patient safety as anything discussed in a conference room.