Ask patients “What matters to you?” rather than “What’s the matter?”BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4045 (Published 22 July 2016) Cite this as: BMJ 2016;354:i4045
- Sosena Kebede, assistant professor of medicine
- Johns Hopkins Bloomberg School of Public Health, the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD 21287, USA
Maureen Bisognano, one of the keynote speakers at this year’s International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden, told delegates that we should ask our patients, “What matters to you?” rather than, “What is the matter?”
The question “What matters to you?” tries to get to the essence of patient centered care, which the Institute of Medicine has listed as one of the priorities for quality improvement.
As physicians, our success in treating illness depends mostly on our ability to diagnose what the matter is with the patient. Pattern recognition, attention to verbal and visual cues from the patient, deductive reasoning, and good clinical judgment are time revered skills that good physicians spend years perfecting.
Patient centered approach
The emphasis on diagnostic skill sets alone, however, has led to approaches in which care is designed around disease and the doctor dictating treatment to the patient. We now recognize that a patient centered approach—where care is structured around patients’ needs, values, and preferences and where they and their loved ones are given opportunities to co-design their treatment plan—leads to better outcomes.
The question “What matters to you?” allows patients to disclose their interests, values, and preferences—as full humans, not just recipients of care
The “sick role,” even for a brief time, is a disempowering and depersonalizing state in which patients have to abide by healthcare professionals’ rules—think for a moment about hospital gowns, intravenous line poles, bed pans, call buttons, bed alarms, blood draws, medical team rounds . . . yet each patient is a son or daughter, sibling, parent, grandparent, spouse, employee, employer, and so on, and each has his or her own identity and unique place in life.
The question “What matters to you?” allows patients to disclose their interests, values, and preferences, and it gives the clinical team a chance to appreciate patients as full humans and not just as recipients of care. This is essential to encourage caregivers’ empathy toward patients.
Research has shown that patients value the quality of interaction with their caregivers, and their perception of this correlates with their overall satisfaction. Asking patients what’s important to them is an invitation to a collaborative communication space that recognizes the importance of good rapport for successful care delivery. In turn, good communication has been shown to increase patient adherence to treatment recommendations.
Responsiveness to public need
Asking questions to find out what really matters to our patients is a great opportunity to improve quality in service delivery. A US Department of Veterans Affairs study on patient centered care found that patients and family members were able to provide “unique perspectives” of veterans’ needs that allowed for a targeted intervention by the healthcare team. Rather than relying solely on biomedical outcomes as their performance indicators (such as hemoglobin A1c or survival) healthcare systems should incorporate patient identified indicators, not only to improve outcomes but also to show the responsiveness of healthcare to the public’s needs.
The optimal way to engage patients and their loved ones in their own care is still not fully clear. Moreover, barriers to engagement include some patients’ inability to fully engage (for social or cultural reasons) and providers’ reluctance to engage with patients (owing to time constraints or a lack of clarity on effective methods). Methods such as the modified Delphi panel, feedback surveys, and patient advisory committees are some of the ways we can try to engage patients. From personal experience, the value of meeting with our patients with the sole intention of finding out what matters to them cannot be overstated.
I recently asked one of my patients what mattered to her, after attempted pain control did not alleviate her distress. In between tears, she told me about her hobbies and family. A lot of what matters to our patients is outside of our clinical armamentarium, and our success in meeting their needs demands our ability to integrate our care with their lives outside of our four walls.
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.