By Bethany M.G. Gomez, JD, RN, BSN, Coverys Risk Management Manager

When it comes to physician decision-making, there are countless factors that impact the diagnosis and treatment of a patient. Among those factors are the physician’s experience and knowledge, specific requests or pressure from the patient and their family, time constraints, and unusual clinical presentations, just to name a few. One key factor that significantly impacts diagnostic decision-making is the degree to which the physician engages the patient and their family in a truly collaborative relationship. 
 
Recognize Built-In Biases 

In the practice of medicine, as with any profession, decision-making is influenced by our built-in biases. When our biases unduly drive our decisions, we can miss opportunities and make mistakes. We come by our biases naturally, but we must be aware of them. Below are a few examples of common biases that negatively impact a physician’s ability to make patient-centered diagnostic and treatment decisions: 

  • Stereotyping. Our biases come from our experiences. So, for example, if your practice has recently seen several drug-seeking patients with opioid dependency, you might assume a new patient asking for pain medication is also a drug seeker. This bias may prevent you from listening to the patient and completing a full work-up. In the alternative, there may be a failure to work up the known drug-seeking patient due to their past behavior when, in reality, they are experiencing a medical emergency.  
  • Overconfidence. Physicians are highly trained experts and experienced in making differential diagnoses. It’s easy to become overconfident about what you know and what you think the patient needs from you. So, it’s helpful to develop processes that include the patient in the conversation from the start. This can prevent undue bias that can lead to an inaccurate diagnosis and/or a treatment plan that doesn’t fit the patient’s life, values, or complete health picture.
  • Being in a rush. Some biases stem from the harried medical system we now operate in. When rushed, you might look at just a few key symptoms or aspects of a patient’s history without delving into the broader picture. That tendency can cause you to miss key signs of what’s really happening.
  • Ascribing all new medical issues to the patient’s chronic illness or previous diagnosis. There is an all-too-common tendency in the practice of medicine to rely too heavily on one piece of information ― typically the first piece of information known ― when making decisions. This easily occurs with patients who are being treated for a chronic illness. For example, if your patient is diabetic, it’s easy to assume their foot pain or lightheadedness may be related to their diabetes. Similarly, we can be guilty of “anchoring,” or accepting a patient’s previous diagnosis (from the emergency department or elsewhere) without further thought. But it’s always possible for a patient to present with new symptoms entirely unrelated to other chief complaints or previous diagnoses, so it’s imperative to keep an open mind and keep asking questions.
  • Believing the patient has little to offer during the decision-making process. The era or timeframe in which we are educated and trained can significantly influence our tendency (or lack thereof) to behave and communicate in a patient-centered way. As medical schools and residency programs evolve, they are increasingly promoting and teaching a patient-centered approach rather than from a paternalistic perspective.
 Four Tips for a More Patient-Centered Approach
  1. Ask the patient, “How is this affecting your daily life and what are your expectations?” For a patient with an ankle injury, it’s important to know more than just how it feels during her appointment. Can she still walk at the end of the day? Is she no longer able to go up or down stairs? Regardless of a patient’s illness or injury, you’ll make your best decisions with them if you understand how their health issue is impacting their daily life and work.
  2. Commit it to paper. When patients come in, write down the answers to these key questions: “What brings you in today?” … “What is your pain level?” … “What would you like for us to do for you today?” …. “Where would you like to be by your follow-up appointment?” Having the conversation fosters shared decision-making and better decisions as well. Documenting the expectations of the patient and your response to those expectations sets the record straight if the patient becomes dissatisfied and considers filing suit.   
  3. Never stop learning. Next time you see a CME-eligible course on effective communication, patient-centered care, decision-making, or patient engagement, jump at the chance to participate. Refreshing your skills results in better patient outcomes.
  4. Remember to talk about and think about your patients as people and not as a diagnosis. Check yourself and your team if you hear someone say, “Karen, the diabetic patient, is coming in today at 1:00 p.m.” Karen is not just a diagnosis to be treated. Reframe that sentence like this: “Karen is coming in at 1:00 p.m. today to talk about her dizziness and urinary symptoms.” Thinking of Karen’s discomforts and concerns apart from her diagnosis increases the likelihood that you’ll catch issues in their tracks. By focusing just on her diabetes, you’re likely to think her dizziness has an obvious and common cause ― glucose and dehydration. But Karen could have a cardiac issue, and you might miss if it you don’t ask about heart palpitations and if you don’t ask when she is experiencing her symptoms. And it’s too easy to think her urinary symptoms are due to her diabetes mellitis when she could be hypovolemic as a result of diabetes insipidus.
While patient outcomes are always our top motivator, there are ancillary benefits to making better decisions through patient-centered care. In an era of new quality metrics, healthier and happier patients can impact financial reimbursement for your practice, HCAHPS scores, institutional funding, and even whether a patient is likely to forego a lawsuit if something doesn’t go well in the end. Patient focus creates better decisions and better decisions precede optimal results.
 
Interested in reading more insights and tips about patient-centered care, patient engagement and shared decision-making? Be sure to check out our three-part series by Ginny Adams
 
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No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.