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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.
An invaluable guide to becoming a competent and compassionate physician. Medical students and physicians-in-training embark on a long journey that, although steeped in scientific learning and technical skill building, includes little guidance on the emotional and interpersonal dimensions of becoming a healer. Written for anyone in the health care community who hopes to grow emotionally and cognitively in the way they interact with patients, On Becoming a Healer explains how to foster doctor-patient relationships that are mutually nourishing. Dr. Saul J. Weiner, a physician-educator, argues that joy in medicine requires more than idealistic aspirations-it demands a capacity to see past the "otherness" that separates the well from the sick, the professional in a white coat from the disheveled patient in a hospital gown. Weiner scrutinizes the medical school indoctrination process and explains how it molds the physician's mindset into that of a task completer rather than a thoughtful professional. Taking a personal approach, Weiner describes his own journey to becoming an internist and pediatrician while offering concrete advice on how to take stock of your current development as a physician, how to openly and fully engage with patients, and how to establish clear boundaries that help defuse emotionally charged situations. Readers will learn how to counter judgmentalism, how to make medical decisions that take into account the whole patient, and how to incorporate the organizing principle of healing into their practice. Each chapter ends with questions for reflection and discussion to help personalize the lessons for individual learners.
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