The path to a better health care environment for patients starts with engaging patients in research and decision-making, encouraging dialogue between patients and physicians, and using electronic health records (EHRs) as a collaborative communication tool in the exam room, according to the authors of three separate viewpoint articles published June 11 in the Journal of the American Medical Association.

Additional Resources Viewpoints Articles: 1  | 2  | 3 CardioSource Patient-Centered Care Community HIT Resource Center CardioSmart.org

Patients have a responsibility to take part in care decision-making; however, the responsibility of patients to participate in research is less clear, according to viewpoint  authors Mary E. Tinetti, MD, and Ethan Basch, MD, MSc. The Patient-Centered Outcomes Research Institute (PCORI) says that "patient-centered research is what helps people make informed health care decisions, incorporating their perspectives in assessing health options." As the authors note, the lines between practice and research are "increasingly blurred."

While research participation must remain voluntary, researchers and health care systems can focus on the positive outcome of more empowered patients and more satisfying practice for clinicians by encouraging participation in research. "It is time to reduce the artificial barriers between research on one side and patient-care and practice on the other," write the authors.

In a separate article,  Timothy J. Judson, MPH, Allan S. Detsky, MD, PhD, and Matthew J. Press, MD, MSc, examine the lack of patient engagement during care — particularly surrounding the barriers that "prevent patients and physicians from meaningful question-and-answer exchanges." On the patient side, a reluctance to ask questions — known as "white-coat silence" — can plague patients who fear "being labeled difficult," taking "too much of the physician's time" or the underlying "asymmetry of power" that exists between patients and physicians. Physicians are less likely to embrace dialogue due to time constraints or even competency challenges.

The authors suggest a few solutions to the dialogue dilemma, including implementing the teach-back method, expanding policy reporting data to arm physicians with more information, and even heading toward team-based models of care or payment reform implementation to create "efficiencies in the delivery of care."

"Encouraging patients to ask questions is a start, but needs to be part of a more fundamental reengineering of health care toward a patient-centered experience in which white coats provoke more open dialogue and less apprehensive silence," write the authors.

A third viewpoint article   reasons that EHRs in the exam room can facilitate patient-physician communication. The authors note that EHRs can help via electronic messaging, giving patient access to records, tools and test results that are otherwise difficult to obtain, and giving patients the ability to read over physician notes online post-exam which in turn provides a sense of control in their care.

Amina White, MD, and Marion Davis, MD, write that using an EHR as "a bridge rather than a divider" in the exam room has the potential to enhance the relationship between patient and physician. However, concerns exist when implementing this type of physician-patient dialogue, including the potential to increase anxiety and stress among patients by sharing the screen, as well as the lack of time typically that exists during an exam for a thorough explanation via EHR.

Moving forward, the authors suggest additional studies to further explore the benefits of using EHRs on "quantitative measures of patient activation."

Keywords: Electronic Health Records, Fear, Plague, Physician-Patient Relations, Patient Outcome Assessment, Patient Access to Records, United States, Patient-Centered Care

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