Special Reports

NYC Residents Learn the Art of Patient-Centered Interviewing

One-Day Conference Sponsored by CIR Policy and Education Initiative

At "The Art of Medicine: A Physician-Patient Communication Conference" on November 19, 2011 residents learned techniques like motivational and patient-centered interviewing that are closely linked to more effective patient care and increased patient satisfaction.

The foundation of the patient physician relationship is the ability of the physician to communicate well with his or her patient. Diagnostic and therapeutic tools such as “motivational interviewing” to change problematic health behaviors and “patient-centered interviewing” are strongly associated with adherence to treatment, lower malpractice rates and improved clinical outcomes. The tools also improve patient and physician satisfaction, yet they are not routinely included in a resident’s training.

To help rectify this deficit, the CIR Policy and Education Initiative (CIR PEI) sponsored The Art of Medicine: A Physician-Patient Communication Conference on November 19, 2011 at the New York Academy of Medicine.

Drs. Auguste Fortin, Associate Professor of Medicine at the Yale University School of Medicine and Sheira Schlair, Internal Medicine Associate Program Director at Montefiore Medical Center in the Bronx, taught nearly 150 residents, medical students and faculty how to build efficiency and effectiveness through integrated patient- and doctor-centered interviewing. In just ten minutes, a physician can elicit the patient’s entire biopsychosocial story behind the visit, arrive at the diagnosis, and impress upon patients her care and compassion.

Learn the Five Steps to Beginning a Patient-Centered Medical Interview

“Allowing the patient to tell his/her symptom story is therapeutic,” said Auguste Fortin, MD, MPH. “They don’t necessarily want you to fix everything they tell you about, and they understand and appreciate agenda setting.”

Dr. Robert Schiller, Chair of Graduate Medical Education at Beth Israel Medical Center’s Institute for Family Health, discusses the importance of patient-centered care at the Physician-Patient Communication Conference.

Residents who attended the workshop reported that after being trained to structure their interviews according to this technique, they experienced vastly improved efficiency and control over the interview and greatly enhanced rapport with their patients.

Other experts at the one-day conference spoke on motivational interviewing, resident wellness and overcoming culture barriers.

Speakers included Drs. Jonathan Fader, Assistant Professor of Medicine at the Albert Einstein School of Medicine; Robert Schiller, Chair of the Department of Family Medicine at Beth Israel Hospital; Ethan Fried, Internal Medicine Program Director at St. Luke’s-Roosevelt Hospital Center; Andrew Yacht, Internal Medicine Program Director at Maimonides Medical Center; Farida Khan, Attending Physician at New York Methodist Hospital; and CIR resident Girish Nadkarni from St. Luke’s-Roosevelt.

Thanks to a grant from the Arnold P. Gold Foundation, the conference was videotaped and the CIR Policy and Education Initiative will produce videos and accompanying educational modules available for viewing by spring. In the meantime, visit the CIR PEI website at www.cirpei.org.

Did you like this? Share it:
Leave a comment

Patient Safety Conference Spurs Lincoln to Reduce Hospital-Acquired Infections

At the 2010 CIR-HHC patient safety conference, keynote speaker Dr. Richard Shannon reminded attendees that “Hospital-acquired infections are not inevitable; they are the product of unreliable systems.” Participants were challenged to create one-year plans to reduce HAIs in their own programs.

One success story can be found at HHC’s Lincoln Medical and Mental Health Center. There, Dr. Abdul Mondul, Associate Medical Director and Patient Safety Officer, worked with his multidisciplinary team to reduce catheter-associated urinary tract infections (CAUTIs). CAUTI rates have fallen from 4.7 per 1,000 catheter days in 2009 to 2.9 in 2010 and 0.5 in 2011. Dr. Mondul’s team even reported zero CAUTIs in the first quarter of 2011. The national range is 3.1 to 7.5 CAUTIs per 1,000 line days.

Dr. Mondul’s team first standardized the policy and procedures for using Foley catheters. One significant change was to empower the nurses to remove the catheter after 48 hours if the physician had not reevaluated and renewed the order, thus ensuring that a patient’s catheter was continually reassessed, that it would not remain inserted for long periods of time, and that the nurse and physician would communicate on a standardized basis.

Dr. Mondul emphasized the importance of working in teams and with complete transparency, and focusing on fixing the system rather than blaming the individual. With a working policy to reduce CAUTIs, the next challenge is to maintain a low infection rate. Dr. Mondul offered a closing piece of advice:

“The sustainability piece is important. Keep it on the radar. Make it a priority. It’s hard to motivate anyone to buy into a project or initiative if you don’t give the appropriate background on why we’re doing it.”

Did you like this? Share it:
Leave a comment

CIR on the Front Lines of Medication Safety and Quality Improvement

Mary E. Burkhart, MS, RPh, FASHP; Lt. Col. Jorge D. Carillo, PharmD, MS; and Helen Haskell, founder of Mothers Against Medical Error were the featured speakers of the 2011 HHC Conference Improving Medication Safety Through Effective Communication and Teamwork.

Teamwork—it’s the buzzword in medicine these days, but how often do teams of physicians, nurses, pharmacists, techs and hospital administrators actually discuss a common medical problem?

That was the strength of the November 30 medication safety conference that brought together more than 160 health care professionals from all 11 hospitals in the NYC Health and Hospitals Corporation (HHC) system. The conference focused on a team and systems-based approach to reducing medication errors, with emphasis on the use of opioid and effective pain management. Keynote speakers from the U.S. Army, the Ann Arbor VA Medical Center, and the founder of Mothers Against Medical Error, and a panel of HHC colleagues imparted valuable lessons; participants later broke out by hospital to identify medication safety concerns in their daily work.

“We looked at examples in which minute errors dramatically impacted patients’ morbidity and mortality,” said Dr. Anthony Isenalumhe, a PGY 4 in anesthesiology at Bellevue Hospital. “That was shocking. You don’t think such small events make such a dramatic change.

“Most times when [providers encounter a near miss] they think of it as a personal event and they correct it on that one-on-one level, rather than thinking about it as something that should be corrected on a system-wide level,” he said.

CIR has organized an annual patient safety conference with HHC since 2008. This conference was also co-sponsored by 1199 SEIU and funded by the Federal Medication and Conciliation Service and the CIR Patient Care Trust Fund.

Did you like this? Share it:
Leave a comment