For the past four years, Dr. Gregg Stefanek, who practices family medicine through Covenant HealthCare in Michigan, has conducted orientation sessions for prospective patients in order to provide more information about the practice to help them decide whether it is a good fit. It is a process that has helped forge meaningful relationships among physicians at the practice and their patients, as well as introduce them to the “more is not always better” philosophy of Choosing Wisely.
Before new patients receive an appointment, they are first asked to attend a 30-minute presentation. These presentations happen every two to three weeks, with Dr. Stefanek and his colleagues rotating as hosts in order to introduce the practice’s staff and philosophy, and set the tone for subsequent visits.
“We are all patients too, so we understand how we want to be treated,” Dr. Stefanek said. “Part of the thinking behind the orientation is recognizing how difficult it is to find a primary care provider. We want to offer a helpful session after which the patient can make an informed decision.”
The sessions focus on:
- Highlighting the patient’s role and setting the expectation for an active partnership with physicians
- Encouraging patients to have responsibility for their health and to ask questions
- Discussing appropriate care and outlining how more tests and treatments don’t always lead to better care
Dr. Stefanek said it was not difficult to get buy-in from the health system and the two other physicians in the small-group practice about why the orientation sessions were important. He presented the idea as something that would empower doctors and patients while contributing to a culture that values high-quality care and community engagement.
“The orientations do not require much overhead, but others need to see the value in investing time into the process in order for it to succeed,” he said.
One challenge is that some patients may view the orientation as an inconvenience or a barrier to care. Some never return, but hundreds of patients have gone through the orientation and most appreciate the honest conversation and invitation to participate in healthcare decisions.
“Some patients tell us that they have never had a doctor speak so openly before,” Dr. Stefanek said. “They say that someone is finally saying what they are thinking.”
He also notices a change in the body language after the orientation starts: Patients who might have been slumped back in chairs and disengaged suddenly start to sit up and pay attention. While building trust and meaningful doctor-patient relationships, the orientations also present Choosing Wisely concepts well before any discussion about a certain test or procedure takes place.
“If a patient comes back in and asks about monitoring blood sugar or wants a cancer screening, you have established that partnership from the beginning and they understand when you explain why it might not be the best option,” Dr. Stefanek said. “The patient’s input matters and the conversation usually focuses on appropriate alternatives. Through this process, we are giving patients permission to take care of themselves.”
Dr. Stefanek also views these orientations and subsequent discussions as a way for doctors and patients to share the decision-making burden, which alleviates some of the pressure on physicians and allows them to re-connect with their passion for providing care.