"Our fascination with the topic of contextualizing care began about twenty years ago when the evidence-based medicine movement had taken hold. We noticed that although medical residents were skilled at identifying the latest studies and guidelines, theircare plans often didn't seem appropriate once one considered the life challenges some of their patients were facing. We'd see, for instance, a patient with poorly controlled asthma put on a higher dose of a medication they weren't taking, rather than a cheaper generic, when the context was that they couldn't afford it. We coined the terms "contextual error" to describe these kinds of mistakes and "contextualized care" when patients' care plans are adapted to their life circumstances"--
The best clinicians take into account the life challenges of their patients when planning their care, a process Drs. Weiner and Schwartz refer to as "contextualizing care." Failures to contextualize care, when they results in care plans that seem appropriate from a narrowly clinical perspective but are nevertheless unlikely to achieve their intended aims represent "contextual errors." Prescribing a medication a patient cannot afford when a less costly alternative is available would constitute such an error. Drawing on two decades of research including analysis of nearly 10,000 audio recorded medical encounters, the authors document an unmeasured dimension of quality: the extent to which clinicians attend to patient context, and its substantial implications for health care outcomes and costs.
Listening for What Matters provides a comprehensive overview of research and quality improvement efforts to address the problem of contextual error. This second edition has been revamped and updated to include studies testing clinical decision support tools in the electronic medical record, medical student and resident trainee educational interventions, and an audio-recording based quality improvement program within the Department of Veterans Affairs. This book is a must-read for physicians, other health care professionals, policymakers and administrators, medical students, and medical educators.
Foreword to Second Edition by Carolyn Clancy, MD, MACP
Foreword to First Edition by Kenneth Shine, MD
Introduction
Part I: The Problem
1. Observing the Problem
2. Measuring the Problem
3. The Problem is Everywhere
4. What We Hear that Physicians Don't
Part II: Solutions
5. High Versus Low Performers
6. Better Teaching, Better Doctors
7. Is Lasting Change Possible?
8. What We Can't Measure that Matters
9. Bringing Context Back into Care
Acknowledgments
Notes
About the Authors
Bibliography
Saul J. Weiner, MD, at Jesse Brown VA Medical Center and the University of Illinois at Chicago College of Medicine (UIC COM), and Alan Schwartz, PhD, UIC COM , have spent the last twenty years studying how well physicians adapt care to patient life context. Their work, involving undercover actors and real patients carrying concealed audio recorders, has been published in Annals of Internal Medicine, JAMA - The Journal of the American Medical Association, BMJ Quality & Safety, The Joint Commission Journal of Quality and Patient Safety, Medical Decision Making, and many other publications. They are also the founders and principals of the Institute for Practice and Provider Performance Improvement (I3PI), a public benefit corporation that brings these techniques from research into practice.
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