Speak Up! Addressing the Paradox Plaguing Patient-Centered Care
Authors: Kathleen M. Mazor, Kelly M. Smith, Kimberly A. Fisher, Thomas H. Gallagher
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions3 May 2016Speak Up! Addressing the Paradox Plaguing Patient-Centered CareKathleen M. Mazor, EdD, Kelly M. Smith, PhD, Kimberly A. Fisher, MD, and Thomas H. Gallagher, MDKathleen M. Mazor, EdDFrom Meyers Primary Care Institute and University of Massachusetts Medical School, Worcester, Massachusetts; MedStar Health Research Institute, Hyattsville, Maryland; and University of Washington, Seattle, Washington., Kelly M. Smith, PhDFrom Meyers Primary Care Institute and University of Massachusetts Medical School, Worcester, Massachusetts; MedStar Health Research Institute, Hyattsville, Maryland; and University of Washington, Seattle, Washington., Kimberly A. Fisher, MDFrom Meyers Primary Care Institute and University of Massachusetts Medical School, Worcester, Massachusetts; MedStar Health Research Institute, Hyattsville, Maryland; and University of Washington, Seattle, Washington., and Thomas H. Gallagher, MDFrom Meyers Primary Care Institute and University of Massachusetts Medical School, Worcester, Massachusetts; MedStar Health Research Institute, Hyattsville, Maryland; and University of Washington, Seattle, Washington.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-2416 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Beneath the patient-centered rhetoric that dominates health care lurks a major paradox: The language of patient-centered care is omnipresent, but the reality is falling short. Patients are bombarded with surveys, post-discharge calls, opportunities to share "compliments and concerns," and requests to "speak up." In actuality, patients' perceptions of care are often ignored and rarely translate into improvements. Two flaws underlie this paradox.First, current approaches place the burden on patients to voice their concerns. However, patients tend not to speak up, even when they believe that something has gone seriously wrong (1–3). Patients, and often family members, fear that mentioning ...References1. Mazor KM, Roblin DW, Greene SM, Lemay CA, Firneno CL, Calvi J, et al. Toward patient-centered cancer care: patient perceptions of problematic events, impact, and response. J Clin Oncol. 2012;30:1784-90. [PMID: 22508828] doi:10.1200/JCO.2011.38.1384 CrossrefMedlineGoogle Scholar2. Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making. Health Aff (Millwood). 2012;31:1030-8. [PMID: 22566443] doi:10.1377/hlthaff.2011.0576 CrossrefMedlineGoogle Scholar3. Rainey H, Ehrich K, Mackintosh N, Sandall J. The role of patients and their relatives in 'speaking up' about their own safety - a qualitative study of acute illness. Health Expect. 2015;18:392-405. [PMID: 23332029] doi:10.1111/hex.12044 CrossrefMedlineGoogle Scholar4. Gallagher TH, Mazor KM. Taking complaints seriously: using the patient safety lens [Editorial]. BMJ Qual Saf. 2015;24:352-5. [PMID: 25977314] doi:10.1136/bmjqs-2015-004337 CrossrefMedlineGoogle Scholar5. Berwick DM. A primer on leading the improvement of systems. BMJ. 1996;312:619-22. [PMID: 8595340] CrossrefMedlineGoogle Scholar6. Davies E, Cleary PD. Hearing the patient's voice? Factors affecting the use of patient survey data in quality improvement. Qual Saf Health Care. 2005;14:428-32. [PMID: 16326789] CrossrefMedlineGoogle Scholar7. Weissman JS, Schneider EC, Weingart SN, Epstein AM, David-Kasdan J, Feibelmann S, et al. Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do not? Ann Intern Med. 2008;149:100-8. [PMID: 18626049] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Meyers Primary Care Institute and University of Massachusetts Medical School, Worcester, Massachusetts; MedStar Health Research Institute, Hyattsville, Maryland; and University of Washington, Seattle, Washington.Grant Support: By the Agency for Healthcare Research and Quality (grant 4R18HS022757-03).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2416.Corresponding Author: Kathleen M. Mazor, EdD, Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605; e-mail, Kathy.[email protected]org.Current Author Addresses: Dr. Mazor: Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605.Dr. Smith: MedStar Health Quality & Safety, 5565 Sterrett Place, Suite 210, Columbia, MD 21044.Dr. Fisher: University of Massachusetts Medical Center, University Campus, 55 Lake Avenue North, Worcester, MA 01655.Dr. Gallagher: University of Washington, 1959 Northeast Pacific Street, Suite BB-1240, Box 356526, Seattle, WA 98195-6526.Author Contributions: Conception and design: K.M. Mazor, K.M. Smith, T.H. Gallagher.Analysis and interpretation of the data: K.M. Smith, T.H. Gallagher.Drafting of the article: K.M. Mazor, K.M. Smith, K.A. Fisher, T.H. Gallagher.Critical revision of the article for important intellectual content: K.M. Mazor, K.M. Smith, K.A. Fisher, T.H. Gallagher.Final approval of the article: K.M. Mazor, K.M. Smith, K.A. Fisher, T.H. Gallagher.Obtaining of funding: K.M. Mazor, K.M. Smith.Administrative, technical, or logistic support: K.M. Mazor, K.M. Smith, T.H. Gallagher.This article was published at www.annals.org on 9 February 2016. 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