Healthcare in a land called PeoplePower: nothing about me without me.

In a 5-day retreat at a Salzburg Seminar attended by 64 individuals from 29 countries, teams of health professionals, patient advocates, artists, reporters and social scientists adopted the guiding principle of 'nothing about me without me' and created the country of PeoplePower. Designed to shift health care from 'biomedicine' to 'infomedicine', patients and health workers throughout PeoplePower join in informed, shared decision-making and governance. Drawing, where possible, on computer-based guidance and communication technologies, patients and clinicians contribute actively to the patient record, transcripts of clinical encounters are shared, and patient education occurs primarily in the home, school and community-based organizations. Patients and clinicians jointly develop individual 'quality contracts', serving as building blocks for quality measurement and improvement systems that aggregate data, while reflecting unique attributes of individual patients and clinicians. Patients donate process and outcome data to national data banks that fuel epidemiological research and evidence-based improvement systems. In PeoplePower hospitals, constant patient and employee feedback informs quality improvement work teams of patients and health professionals. Volunteers work actively in all units, patient rooms are information centres that transform their shape and decor as needs and individual preferences dictate, and arts and humanities programmes nourish the spirit. In the community, from the earliest school days the citizenry works with health professionals to adopt responsible health behaviours. Communities join in selecting and educating health professionals and barter systems improve access to care. Finally, lay individuals partner with professionals on all local, regional and national governmental and private health agencies.

Inability of an "energy transfer diagnostician" to distinguish between fertile and infertile women.

CONTEXT: Various forms of "energy healing" have become popular in the United States. OBJECTIVE: To test the assertion that an energy healer can, without physical contact, distinguish the presence or absence of internal organ pathology in individuals who lack overt physical findings. DESIGN: Observational randomized study, in which we tested the assertion by a well-recognized alternative healer that he had particular skill in using energy transfer to detect the presence or absence of fertility disorders in women. PATIENTS: Convenience sample of 37 women, 28 of whom had documented pathology resulting in infertility, and 9 of whom were fertile. OUTCOMES: The healer was provided with no medical history and performed diagnostic evaluations without physical contact with the blindfolded, clothed, and silent subjects. We compared to random chance the ability of the healer to establish a diagnosis of fertility or fertility disorder. SETTING: Teaching hospital. MAIN RESULTS: The healer was unable to distinguish the presence or absence of fertility disorders in the study subjects. CONCLUSION: This study points to further need for fair yet rigorous assessment of claims that energy transfer can lead to accurate clinical diagnoses.

Hospital medicine: understanding and drawing on the patient's perspective.

Poor communication and distance may result when the perspectives of clinicians and patients differ. Individual interviews, focus groups, and surveys of patients can inform health professionals about patient expectations and experiences with care. Hospital medicine will advance by learning from patients and their families and involving them in efforts to monitor and improve care.

Carepartner experiences with hospital care.

OBJECTIVES: Family members and other "carepartners" often play an important role in the care and support of patients during and after hospitalization, yet little is known about how they assess their hospital experience or the factors that may influence their perceptions. METHODS: A nationwide telephone survey of 1,800 recently discharged patients and their carepartners about their hospital experience was conducted. Carepartner responses in six domains of care were summarized, and multivariable regression analysis was used to detect independent predictors of more frequent problem reports by carepartners. RESULTS: Carepartners reported problems most frequently in the domains of emotional support (23.9%), discharge planning (20.3%), and family participation (17.6%). Independent predictors of more frequent carepartner problem reports included poor subjective patient health status, emergency hospitalization, nonsurgical admission, carepartner income less than $7,500/year, younger carepartner age, noninvolvement of the patient's regular doctor, less frequent carepartner visits during the hospitalization, and less time spent with the patient after discharge. CONCLUSIONS: Better awareness of the problems carepartners experience and attention to improving quality in these areas may facilitate family involvement in patient care and enhance carepartner and patient satisfaction.

Perceptions of quality of care and the decision to leave a practice.

Little is known about how patients' perceptions of quality of care influence behavioral outcomes such as decisions to change the source of their care. We surveyed patients suspected of leaving a primary care internal medicine practice at an urban teaching hospital to examine their reasons for leaving, and to investigate whether decisions to leave were related to perceived quality of care. Of 185 respondents, 27 (15%) had left to follow their doctor to another practice. The other 98 (53%) patients who had left the practice cited reasons such as a change of insurance (51), physician care (31), practice operation (27), parking and transportation (24), physician departure (19), and geographic moves (17). Responses to global assessment items and a physician care rating scale were more closely associated with the decision to leave than were ratings of other specific aspects of care.