Patient-reported Outcome Measures: A Stethoscope for the Patient History

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Excerpt

John Doe stands in the burn clinic waiting room, accompanied by his visibly concerned wife. He is pacing, unable to tolerate the pins and needles in his burned legs that occurs whenever he stands still. Just 3 months ago, John worked 2 jobs to support his family of 5, and there was barely enough money to get by. The factory fire caused burns to half his body. His wife is grateful that he survived and that he is now home. However, life has changed dramatically for both of them. Now they are facing the realities of getting by each day. Their lives are disrupted by financial woes and their future is unclear. John spends his days with therapists and his wife tends to his dressings and medications. They are looking to the doctor to explain what comes next, but the litany of symptoms and the magnitude of the disruption in their lives are difficult for them to verbalize. Their follow-up appointment is booked for 40 minutes. The burn surgeon comes in, asks in general how things are going, asks about pain, typing on the computer as he goes, trying to navigate the electronic medical record, and doing his best to complete the “meaningful use” documentation requirements. Then, he removes dressings, performs the examination, replaces dressings, discusses reconstructive options, reviews medications, obtains surgical consent, discusses scheduling of the next procedure and the visit is over. During the ride home, while they were reassured all was improving, John and his wife had more questions. How long will he have the pain? What can be done for his sleeplessness? They wonder when and if he can ever return to work. John's wife is concerned that he is not going out in public because of his visible scars and worries how this will affect his self-esteem.
Scenarios such as this are playing out in busy medical offices across the country every day, no matter if it is a burn survivor, a postoperative patient, a pregnant teen, a gentleman with chronic progressive rheumatoid arthritis, or a family struggling with a parent with early-onset dementia. In the era of value-based healthcare and quality improvement, despite best intentions, physicians face mounting administrative pressures in their daily workflows and the patients feel increasingly shortchanged. Patients may feel lost in a system that churns them in and out of waiting rooms and where their physicians are increasingly preoccupied with the administrative burden of clinical care. Questions are left unasked, anxieties unaddressed. In this taxed and pressured environment, how can we accommodate the need for standardization and efficiency without diminishing the humanity of patient encounters? The vision made in 1988 by Paul Ellwood was to see healthcare from the eyes of the patient. This early concept has been recently introduced into the health system as Ellwood imagined using patient-reported outcome measures (PROMs). 1 PROMs are powerful tools that can bridge the need for data-driven patient information while also strengthening the physician-patient connection. When maximized in clinical settings, PROMs can be leveraged to inform clinical decision making, to improve quality of care, and to foster communication between patients and providers. PROMs are a tool for patient-provider communication and have the potential to be as valuable to the clinical encounter as a stethoscope is to the physical examination. This article is a clarion call for physicians to implement PROMs into their practice and for researchers to study their potential value in the clinical setting.
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