Monday, February 14, 2011

The Human Centered Health Home: Building Trust by Sharing Patient and Physician Uncertainty

"Years ago, I thought that everything doctors said was totally true.  The treatment for an illness was one hundred percent effective, I would always respond by being cured.  I'll never forget the time my family doctor sat me down to clarify what my oncologist meant by five year survival percentages.  Then I was afraid for a while.....  In a few months, though, I realized how much more trust I had in my family physician than previously.  I realized that he wasn't going to withhold the truth from me when I needed it."  

Many patients have expressed thoughts like these about trust and uncertainty to physicians over the years.  This era with more complexity and uncertainty may require patients and doctors both to upgrade their sharing and trusting skills.  As the complexity in the modern health care world increases, patients and physicians both deserve the opportunity to make their best decisions, individually and together.  Trusting each other enough to share uncertainty may enhance the quality and results of their complex decisions.

How do we know when patient and doctor are relating well enough to be safe and effective with their decisions?  How might each relate their certainty and uncertainty about information that should be and is shared?  How and when do they acknowledge and/ or clarify understandings and misunderstandings?  How might each one know when to withhold disruptive information (usually for later sharing) due to the  temporary or permanent vulnerability/suffering of the other person (which usually would abate, allowing the sharing of the withheld information)?
The uniqueness of the Human Centered Health Home (HCHH) model contributes to better sharing of uncertainty starting with its emphasis on Human Centering of the patient and physician.  Their humanity and commitment to humanity starts the relationship before the roles of patient and physician emerge.  This is followed with the six step process of the HCHH including Respecting, Protecting, Connecting, Detecting, Correcting and Reflecting by patient, physician and the dyad of patient and physician.
Some specific aspects of the six steps that allow sharing of certainty/uncertainty and (therefore) trust building are:                                                                                                         
                Respecting:  Patient and Physician respect themselves and each other enough to allow the “truth” to be shared, including uncertainty about important (if not all) aspects of the diagnostic, therapeutic and administrative processes.  The timing of the sharing may vary depending on the communication style of the patient- physician dyad and comfort levels of each during the engagement.  Each learns to respect the roles that they may manifest during the engagement and across the relationship's lifespan.  (Including roles as human, patient, physician, consumer, consumer coach, steward, teacher, learner, friend, neighbor, leader, follower, household member, head of household, etc)
                Protecting:  Both protect the time allotted for this engagement and the time allotted for scheduled engagements before and after this one, including those of other patients, family and friends.  Both members of the dyad and office staff are protected from unreasonable aspects of health care process and the Medical Industrial Complex (MIC).  Both protect each other from unreasonable expectations and their respective family of origin pathologies.  Both protect each other by timely sharing and withholding of information as they realize when and how the other and the dyad is most vulnerable and most powerful. 

                Connecting:  The dyad works to connect as humans first, considering and clarifying each persons context. (see posts- 11/22/10, 11/30/10, 12/03/10)  Then they may choose to connect via other roles such as patient and physician, once their shared humanity strengthens their trust and helps to protect them.  They use  three or more of the five senses to connect as they allow trust to develop.

                Detecting:  While detecting patient alignment with goals and dreams, the physician may do likewise to enhance their wholeness and ability to respond effectively to the patient's situation.  Therein they will detect and share the certainty and uncertainty of each person’s insights about current and ongoing problems and situations as they relate to the current and future engagements of the dyad.  They share in detecting supporting information that may clarify a better understanding of probabilities that impact their individual and shared decisions.

                Correcting:  While developing a shared plan for addressing the realignment of patient situation with patient goals and dreams, both will seek to further clarify levels of certainty and uncertainty using available resources.  They will each give their perspective on the important probabilities that impact the current decisions facing the dyad and seek to correct misunderstandings about the probabilities under consideration.  After sharing their perspectives they will merge their understandings as possible and go ahead with the plan for correction.

                Reflecting:  They will reflect on the dyadic interaction and share their perspectives on the trust levels of the dyad.  They will each allow and accept that the interaction and the decision process happened.  Both will reflect on levels of certainty and uncertainty involved in the agreed to decisions and identify if any need exists for later clarification.  Both will reflect on their sense of trust in each other and their process of communication.   They may elect to forgive themselves, the other or the dyad as indicated as they seek to nurture the relationship via the HCHH process.


  1. Not sure that this is on topic, but I just got a new book by a neuroscientist named V.S. Ramachandran called, "The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human".
    It seems like something that I would find on the bookshelf in your office!

  2. Thanks for your comment, Stephanie, the book sounds interesting. You're right, I have many titles about brains, humans, behavior, love, connecting, helping, thinking, leading, being. I have mentioned The Mind and the Brain by Schwartz on my BTR show. Thanks again.

  3. Sorry for not responding to this post sooner, but now that I've had some time to take it in, may I ask where this model was developed?
    There is a lot to like about this model, I would be interested in seeing any research on where this model has been implemented.

  4. Penelope, thanks for asking. The model comes from years of study and training and practice and teamwork. Parts have been presented at the FMEC, Inc NE Regional Meeting over the last ten years. The HCHH focus evolved, then, through the Center for Innovation in Family and Community Health (CIFCH), our think tank for innovation in Beavercreek, during the last 18 months. That model (HCHH)was presented at FMEC NE meeting in Hershey, PA and The Applied Human Factors and Ergonomics International meeting in Miami, FL in July, 2010.
    The model is untested in current form. I use it daily to guide my interaction with patients in my Family Practice office in Beavercreek, OH. The Dr Synonymous Blog includes several references to HCHH elements.
    I especially appreciate the human part that frees both parties from being trapped in only one role. More in later posts.