Listening for What Matters
Saul J. Weiner, Alan Schwartz
Abstract
Abstract Listening for What Matters: Avoiding Contextual Errors in Health Care, 2nd edition (LFWM2) provides a comprehensive overview of research and quality improvement efforts to address the problem of inattention to patient life context during clinical encounters that undermine effective care. Such “contextual errors” occur when patient care plans that are otherwise consistent with research evidence for managing a particular clinical condition are, nevertheless, inappropriate for a particular individual based on their life situation, or patient context. Prescribing a medication a patient can’t afford and proposing a treatment plan they don’t have the skills or resources to follow when alternative options are available are examples of contextual error. Identifying contextual errors requires listening in on visits, by employing either unannounced standardized patients (undercover actors) or real patients who volunteer to audio-record encounters. LFWM2 synthesizes nearly two decades of published research employing these unconventional methods to demonstrate how they yield critical and otherwise inaccessible information about physician performance at contextualizing care, including its implication for patients’ health-care outcomes and unnecessary care. The authors also describe 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 to prevent contextual errors. They argue that, ultimately, a greater recognition among payers and the general public of the implications of contextual errors on quality of care and costs is essential to the widespread adoption of methods for identifying and preventing contextual errors.