Communication Solution: Stop (just) Training Doctors, Start Training Patients

Gabby Ceccolini, MS
Healthcare Communication Specialist

The Problem with Patient-Centered Care

For decades, our healthcare system has poured time, money, and innovation into training doctors to communicate better; however, what if we are overlooking the other half of the equation?

The term “patient-centered” began appearing in medical literature in the late 1980s. It wasn’t until 2001 when the Institute of Medicine report Crossing the Quality Chasm¹ made “patient-centered care” one of the six national pillars of quality.  What does that mean exactly?

The article calls out that the focus of care needed to shift from “doctor knows best” to “patient as partner.” Doctors needed to focus on collaborating with their patients and including their patients in decision making, giving them authority over their own health. The report was a call to action, asking for a fundamental redesign of care. Doctors needed to listen to their patients’ voices and allow them to use that voice in making decisions when it comes to their care.

Ultimately, the model of patient-centered care is supposed to put the patient at the center of care; however, the Institute of Medicine was designed to target physicians and other health professionals, not the patient. The entire healthcare system was redesigned in a way that gave both sides of the stethoscope equal importance yet gave no specific guidance to patients; hence overlooking half of the equation. The Institute of Medicine called for a fundamental redesign of care: Is it time for a fundamental redesign of the patient’s role? 

Creating a Patient Training Model

For more than a decade, I’ve been immersed in the world of medical education. I’ve spent time hiring, training, and directing standardized patients (SPs) who help future clinicians practice essential communication skills.² SPs are individuals who are hired and trained to portray patients so future and current clinicians can practice communication, empathy, and clinical interviewing skills. The SPs would often comment that given their robust training as fake patients for their job, it made them better patients in real life, as they were better able to communicate with doctors.

A lightbulb moment for me! Hearing the concept of a “better patient” coming directly from the patient in a way that was proud, not timid, and as a result of being trained, not just a perception of “better.” I studied this and learned that their knowledge did, in fact, lead them to feeling heard, informed, confident, and in control of their health. They felt like actual partners with their healthcare providers – a feeling all patients are entitled to.

This discovery led me to do a deep dive into what exactly it was about the job and the training that made the SPs feel this way. I translated that content into language and a framework to teach patients in the community, ultimately teaching patients how to be the “center” of patient-centered care.

The model: Patients are shown how their role impacts the decisions that doctors make about their care plan, structured as a “15-minute medical visit” in three simple parts:

1. To be heard, doctors must be trained to listen. Patients can be trained to have medically relevant conversations.
2. To be informed, doctors must be trained to educate. Patients can be trained to recognize when information-sharing is happening.
3. When both sides are equipped to communicate, when both sides have knowledge of a similar framework for the “15-minute medical visit,” the visit transforms from a rushed or confusing transaction into a meaningful, efficient, and collaborative partnership. Ultimately, it leads to outcomes such as better health, safer care, happier patients, more satisfied clinicians, lower cost, and more equity.

Key Takeaways

• Patient-centered care relies on a strong partnership between the patient and the provider, yet the current state overlooks the guidance needed for patients on how best to engage in that partnership.
• The mental model of patients could benefit from a fundamental redesign of their role in healthcare, one that is empowered and equipped with the tools to enhance their partnership with providers.
• Several studies have shown a positive impact of standardized patient (SP) training on individual SPs’ experiences as actual patients; the training SPs get for their job as an SP positively impacts their real-life experiences as patients.
• Training patients – or those who support and advocate for patients – may be the solution to strengthening the partnership between the provider and the patient.

Is This The Answer?

There is more work to be done in this important yet relatively under-examined area. I understand this is not a one-size-fits all solution, and I understand there are significant barriers when it comes to communication and care. However, I think there is an opportunity here. It’s time we think outside the box to find a solution by extending an invitation for patient training. If patients decline, there is no loss; the outcome is that we remain at the current state of care. However, for those who choose to participate, the potential exists for significant improvements in communication, understanding, and partnership between doctor and patient. A true win for medicine all around.

References

¹ Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21^st Century. Washington (DC): National Academies Press (US); 2001

² Gabbriel Ceccolini, Mattel Kanevsky, Richard Feinn, Ingrid Philibert, Adapting standardized patient training to improve patients’ understanding and preparedness for health care encounters, Patient Education and Counseling, Volume 125, 2024, 108276, ISSN 0738-3991, https://doi.org/10.1016/j.pec.2024.108276.

About Gabby Ceccolini

For 13 years, Gabby has served as the Director of a Standardized Patient & Assessment Center at the Frank H. Netter MD School of Medicine at Quinnipiac University. In this role, she has hired and trained hundreds of individuals to portray patients so medical, nursing, and health science students, as well as practicing physicians, can practice communication, empathy, and clinical interviewing skills. Gabby has guided thousands of clinical encounters, giving her rare insight into what truly builds trust between patients and providers, using that knowledge to bridge the gap between what doctors intend to communicate and what patients actually hear and understand. Her research focuses on how training patients impacts medical visits. The author’s ultimate mission is simple: to improve healthcare by making the medical visit better.

Contact: Gabby@bettermedvisit.com