RESUMO
Patients are often reluctant to assert their interests in the presence of clinicians, whom they see as experts. The higher the stakes of a health decision, the more entrenched the socially sanctioned roles of patient and clinician can become. As a result, many patients are susceptible to "hostage bargaining syndrome" (HBS), whereby they behave as if negotiating for their health from a position of fear and confusion. It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one's better judgment. When HBS persists and escalates, a patient may succumb to learned helplessness, making his or her authentic involvement in shared decision making almost impossible. To subvert HBS and prevent learned helplessness, clinicians must aim to be sensitive to the power imbalance inherent in the clinician-patient relationship. They should then actively and mindfully pursue shared decision making by helping patients trust that it is safe to communicate their concerns and priorities, ask questions about the available clinical options, and contribute knowledge of self to clinical decisions about their care. Hostage bargaining syndrome is an insidious psychosocial dynamic that can compromise quality of care, but clinicians often have the power to arrest it and reverse it by appreciating, paradoxically, how patients' perceptions of their power as experts play a central role in the care they provide.
Assuntos
Atitude Frente a Saúde , Tomada de Decisões , Desamparo Aprendido , Poder Psicológico , Relações Profissional-Família , Relações Profissional-Paciente , Empatia , Humanos , ConfiançaRESUMO
Patient-centered access (PCA) to primary care services is rapidly becoming an imperative for efficiently delivering high-quality health care to patients. To enhance their PCA-related efforts, some medical practices and health systems have begun to use various tactics, including team-based care, satellite clinics, same-day and group appointments, greater use of physician assistants and nurse practitioners, and remote access to health services. However, few organizations are addressing the PCA imperative comprehensively by integrating these various tactics to develop an overall PCA management strategy. Successful integration means taking into account the changing competitive and reimbursement landscape in primary care, conducting an evidence-based assessment of the barriers and benefits of PCA implementation, and attending to the particular needs of the institution engaged in this important effort. This article provides a blueprint for creating a multifaceted but coordinated PCA strategy-one aimed squarely at making patient access a centerpiece of how health care is delivered. The case of a Wisconsin-based health system is used as an illustrative example of how other institutions might begin to conceive their fledgling PCA strategies without proposing it as a one-size-fits-all model.
Assuntos
Guias como Assunto , Assistência Centrada no Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Humanos , Estados UnidosAssuntos
Organizações de Assistência Responsáveis/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde , Equipe de Assistência ao Paciente/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Organizações de Assistência Responsáveis/normas , Instituições de Assistência Ambulatorial/normas , Prestação Integrada de Cuidados de Saúde/normas , Humanos , Relações Interprofissionais , Masculino , Minnesota , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/radioterapia , Estudos de Casos Organizacionais , Equipe de Assistência ao Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Garantia da Qualidade dos Cuidados de Saúde/normas , Recursos HumanosRESUMO
The strategic planning process is not complete without meaningful physician involvement.