Reflections on the 2011 IHI National Forum (Part I): Listening to the Patient

As I sat down to write up my thoughts from the IHI National Forum, I realized that it was far more than could be adequately covered in one post (unless said post was incredibly long), so I’ve broken it out into a few posts – Enjoy!

I can remember after one of my first patient encounters, I was still a first year medical student who had barely learned how to take a history, let alone a physical exam. With a few other medical students, I was driving home from a medical-student run free clinic and one of the other volunteers was saying, “I can’t believe I didn’t realize that woman was depressed.” I admitted being surprised as well. It was totally unexpected and not in her chart, even if for the patient it was something that had happened before. However, I remember thinking that we shouldn’t have been beating ourselves up for not knowing — because that is why we needed to ask, and then listen to the patient’s story.

Remembering that experience, I am thankful that listening to patient’s stories was also one of the themes at the IHI national forum this year. From the [very beginning keynote](, Maureen Bisognano, the CEO of IHI, highlighted the importance of hearing and retelling stories for moving quality improvement forward.

She talked about a care coordination program, where the nurse going into a patient’s home to make sure that they were taking their medications and otherwise safe in their homes, asked the critical question, “what do you need?” The patient requested a dog, and though the nurse at first hesitated because that did not seem in her job description, she stopped by the city pound on her way to her next visit to that patient and got her a dog. The patient, who was previously bed-ridden, was able to become more mobile again and even began going out to play the violin for the other patients in the nursing home.

There is no hard and fast evidence that I know of that patient participation in quality efforts is a cost-effective, sure-fire way to improving health care. But the fact of the matter is: without patient participation, how can you know that what you are doing is actually improving the lives of patients? how can you know that you are addressing their real needs until you ask? We can talk until we’re blue in the face about shared decision-making and patient-centered care, but it means absolutely nothing unless the work that we are doing actually involves patient participation and addresses their real needs.