I recently returned from the American College of Physicians (ACP) annual meeting in Washington, DC. The ACP is the largest medical specialty organization in the world, with 147,000 members spanning the spectrum from medical students starting off on their careers to seasoned clinicians in practice and medical school professors. Both general internists practicing primary care and hospital medicine and subspecialists in every organ system were well represented. As a career-long member of the ACP, I was particularly struck and gratified by their commitment to patient-centered care in general and shared decision making (SDM) between clinicians and patients in particular.
Three years ago the ACP launched its Center for Patient Partnership in Healthcare (CPPH) to help patients become informed advocates and active partners in their care—very similar to our own mission to help people make better health decisions! The CPPH is directed by Wendy Nickel and guided by the Advisory Board for Patient Partnership in Healthcare. The advisory board, chaired by Dr. Phyllis Guze, includes patient advocates, with representatives from the National Partnership for Women and Families and the Society for Participatory Medicine, as well as a diverse group of health care professionals, not just physicians. I was gratified to be asked to join the advisory board going forward, and I will look forward to helping set its patient-centered agenda.
Another interesting development at the ACP is the incorporation of patients into the development of its clinical practice guidelines. The ACP has a long-standing history of developing unbiased, evidence-based guidelines for the clinical management of a host of conditions, from insomnia to depression to diabetes treatment. These recommendations for clinical practice are developed by the ACP’s Clinical Guidelines Committee. However, in the past, this committee has only included physicians. To make sure its guidelines incorporate the patient perspective, the ACP has recruited and is training nine patient representatives in the principles of evidence-based medicine and guideline development so the patient perspective can become a routine part of the guideline development process. This development should help prevent the circumstance where a guideline tells physicians to do one thing, while many informed patients want something else. As a member of the committee, I very much look forward to working with these new members!
At the meeting itself, I presented on the value of using generic drugs, based on an analysis done by the Clinical Guidelines Committee. Using generic drugs makes sense not only to save people and the health system money, but also to increase the likelihood that patients will fill their prescriptions and take their medicines. The evidence in study after study documents that use of generics increases patient adherence to needed medications. I also presented a session on the pros and cons of lung cancer screening with low-dose CT scans. Screening for lung cancer in this way can prevent some lung cancer deaths, but at a high cost in terms of false positive results, generating needless anxiety and interventions. Because the decision is such a “close call,” Medicare will pay for the screening only after an SDM visit where a decision aid was used to ensure an informed decision consistent with patient preferences. Both these sessions were well-attended and reflected an overall patient-centeredness to the meeting. Sessions by other speakers covered topics such as motivational interviewing, engaging the e-Patient, shared decision making, and communication essentials for patient-centered care. An innovative session, "In the Patient's Voice," featured a patient who has suffered from a chronic illness since childhood. He discussed the triumphs he'd faced in partnership with clinicians and some of the challenges he experienced when he was not included as a partner in his own care.
And finally, the ACP and Healthwise are already collaborating on a project to improve patient safety through the use of short decision aids on prostate and breast cancer screening. This “Patient Safety Module Project,” funded by a grant from the American Board of Internal Medicine Foundation, will allow us to develop and test an online module to help clinicians use these decision tools to order these screening tests in a way that is consistent with both clinical evidence and patient preferences. We are already talking about other potential collaborative projects focused on making patient-centered care even more of a reality! Clearly, a partnership with such a prestigious professional organization like the ACP is a great way to ensure that patients are ever-increasingly informed and involved in their health care decisions!