Saturday, October 2, 2010

The Human Centered Health Home: Connecting Patient and Physician

The Human Centered Health Home (HCHH) as defined by our Center for Innovation in Family and Community Health is best supported by patient-physician processes which include: respecting, protecting, connecting, detecting, correcting, and reflecting.  Previous posts discussed respecting (7/2/2010) and protecting (7/28/2010 and 8/24/2010 ).  This post introduces connecting for both patient and physician, starting with human to human connection in which both humans somehow recognize their equality and common ground.  The dyad of patient and physician are able to accomplish more if they remember and reaffirm their humanity first.

A behavior that helps to separate them from outside distractions should begin the engagement.  Usually this behavior is touch: a handshake with a greeting and appropriate eye contact may be a good start, while a hand on the shoulder or touch of the forearm may fit better for many.  The thought for both is about greeting an important person with unique attributes who is a neighbor with shared community values.  The need for both is to escape from their last activity and the technology that surrounds them.

The touch strategy has to be altered and "framed in disinfectants" if infection is involved.   A person who is coughing should remember to cough into their elbow and make a commitment to prevent the spread of their infection to their physician and office staff.  Hand sanitizer is liberally placed in physician offices so patients can minimize spread of infection to others by following the rules of "Champion Hand Washing" promoted by the award winning program of Henry the Hand (  Likewise, the family physician, who is frequently exposed to infected individuals, will follow the same guidelines.  Many physicians wash their hands or sanitize them in the patient's presence, sometimes more than once depending on types of contact during each encounter.

The physician also has to recognize their time issues as an element of respect toward the patient that may impact the quality of connection.  If the physician is delayed in their connection to the patient, the physician should speak to the issue, "I'm sorry to hold you up" or "I'm sorry for your wait".  Unfortunately, physicians can't reveal what they were doing that delayed them due to patient confidentiality.  Other comments about physician timeliness are located elsewhere in this series and in some excellent patient and physician blogs.

The human soon to further assume the role of patient gets the most benefit if they are focused and help the physician to focus on this encounter.  A neighborly patient will greet the neighborly physician with eye contact, touch and a connecting comment, such as, "Hi, Dr Smith, how is your new baby doing?" or "You look ready for winter with your bright sweater, Dr. Jones."  The connecting comment should be genuine and help to refresh the physician's humanity (which has just been relating to another person/ patient's humanity and health/ disease  issues possibly followed by, or concurrent with,  interaction with electronic devices) including an intention to separate the physician from distracting technology.

As we get closer to mandatory electronic medical records (EMR) for all patients, they and physicians are vulnerable to more technology driven distractions. We should  remember to start the visit with something that "doesn't compute", i.e. humans.  The basis of the HCHH is the human encounter of the dyad, not the technology and not "the numbers".  It is about two worthy, neighborly humans first and foremost.  The complex work of the dyad is best if it starts with two connected humans.

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