Patient's Review

What are the patient's short-term and long-term goals?

What level of involvement does the patient want in decision making?

What does the patient need, want, or expect from the clinician and the visit?

Learn about, and educate staff about, the health beliefs, practices, and mores of specific ethnic and cultural groups in your patient population.

Use clinical interview protocols that elicit patients' perceptions about their illness and their expectations of treatment.

Develop culturally appropriate standards for staff behavior with patients (for example, forms of address, rules of propriety).

Ask, do not assume: Ask patients what they want to know; suggest questions that patients might have; ask patients if they understand.

Ask, do not assume, how therapeutic decisions affect patients' lives, what patients' preferences would be among alternative treatments and outcomes.

Negotiate therapeutic strategies with patients.

Is care delivered by a range of providers effectively coordinated?

Does the patient get consistent information from different clinicians?

Give patients written and/or visual information identifying members of the clinical team, explaining the role of each, and make sure they know who is in charge of their care.

Identify one person on the clinical team to serve as the primary conduit of information for the patient and his/her family.

Find out about patients' experiences with clinical tests and procedures (for example, about waiting times, delays, pain or discomfort, and the information they were given).

Give patients and their families realistic expectations about waiting times, levels of discomfort, possible side effects, and other factors relating to tests and procedures.

Make sure that staff who come in contact with the patients have the responsibility, ability, and information to get patients what they want or need.

Give all staff who come in regular contact with patients information about special needs, activity restrictions, and other appropriate information.

Encourage staff at all levels to help patients solve their problems, and reward them for doing so.

Does the patient have the information they want about clinical status, diagnostic tests, and treatment options?

Do the patient and family know what they need to know to manage on their own to the extent they are able to do so?

Establish explicit procedures that give patients ready access to knowledgeable health care professionals who can answer questions and give them help. Make sure patients understand and can follow these procedures.

Clarify the goals of patient and provider.

Consider giving patients access to their medical records; encourage questions; invite families and patients to write their goals for treatment in the record.

Make communication a regular topic of staff meetings; use videotapes of real patient interactions to initiate discussion.

Help patients learn negotiation strategies that can "empower" them in discussions with doctors and nurses.

Encourage the patient and family to write down their questions and concerns.

Learn and educate staff about the typical communication needs and patterns of the socio-demographic and cultural groups seen in your practice. Use these to heighten awareness of the differences among patients rather than to reinforce stereotypes.

Identify staff members who have particular skill in translating "technical" language into "everyday" language, and use them to help improve communication.

Tape record important conversations with patients and give them a copy of the tape to listen to later with their families. Encourage them to return with questions or confusion they had after listening to the tapes.

Is pain alleviated as much as possible?

Does the patient have the help they need with bathing, eating, household chores, or other activities of daily living?

Have remediable deficits in functional status been adequately addressed?

Help patients who experience pain communicate about it by asking them to rate the intensity of their pain on a scale of 1 to 10.

Record patients' pain status along with other vital signs.

Educate all clinical staff about appropriate pain control protocols; discuss misconceptions about narcotics and their true risks and benefits.

Assess patients' functional status and available sources of support.

Designate staff to get patients the help they need and reward them for doing so.

Use natural and incandescent lighting wherever possible.

Design traffic flow patterns and waiting areas to respect patients' privacy and need for conversational areas.

Is the patient worried about their illness or its effect on the ability to care for themselves or their family?

What are the principal stresses in the patient's life?

Are they worried about paying medical bills or about lost income due to illness?

Does the patient have access to appropriate support networks to help with these worries?

Make videos on simple relaxation techniques available to patients to help them cope with medication side effects or stressful procedures.

Review with patients the kind of information, assistance, and support they need and the approaches they find most helpful; make this a routine part of the history and physical.

Identify or develop educational materials suited to patients' varied coping styles.

Use focus groups or other methods of eliciting feedback from different types of patients to develop appropriate protocols and materials for administering the Patient Self-Determination Act.

Using focus groups or other methods of patient involvement, plan services and programs with the same concern for patients' psychological and emotional needs that is devoted to their physical requirements.

Identify patients with a serious illness or chronic disability and members of their families who are willing to share their experiences with others newly diagnosed.

Give patients written information about available support and self-help groups.

Are family and friends included appropriately in planning and providing care?

Do they have the support they need?

Make appropriate staff available to counsel, educate, or meet with patients' family members; inform families of their availability.

Encourage family members to write down or express their concerns; include these family notes in the patient's record.

Offer families written or videotaped take-home materials with health information appropriate to their needs.

Identify appropriate family support and referral services in your community.

Train volunteers to visit the patient and family at home to help with unanticipated home care needs, such as filling prescriptions, running errands, coordinating home care services, or providing referrals to community resources.

Develop appropriate protocols for assessing the needs of families of patients with serious or chronic ailments.

Include patients and family members on committees or task forces to plan or evaluate clinical services.

Do the patient and family understand the medications to take, treatment regimens to follow, activities to pursue or avoid, and danger signals to look out for?

Are there clear plans for continuing care and treatment?

Identify the post-hospital needs of patients scheduled for hospitalization prior to their admission.

Identify or design educational services that teach patients what they need to know to care for themselves away from the clinical setting.

Encourage patients to write down their questions; make sure those questions are answered before they leave the hospital or clinic.

Audiotape conversations at critical junctures of the patient's treatment and give patients a copy of the tape to take home.

Make use of nursing or social work case managers to help coordinate care across sites or specialities.

Designate staff to telephone patients after critical office visits or discharge from the hospital.