Listening for What Matters: Avoiding Contextual Errors in Health Care

ISBN : 9780190228996

Alan Schwartz; Saul Weiner
224 Pages
156 x 235 mm
Pub date
Feb 2016
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Effective health care requires physicians tailor care to patients' individual life contexts, including their financial situation, social support, competing responsibilities, and cognitive abilities. Physicians, however, are poorly prepared to consider patients' lives when planning their care. The result is measurably harmful to individuals and costly to society. Listening for What Matters: Avoiding Contextual Errors in Health Care covers ten years of empirical research based on hundreds of recorded doctor visits by patients and undercover actors alike, which revealed a widespread disregard of patients' individual circumstances and needs resulting in inappropriate care. These medical errors have been largely undocumented and unaddressed by the American healthcare system. This book tells the stories of patients whose care was compromised by inattention to individual context, and introduces novel methods for assessing the magnitude of the problem. It describes how these errors, termed "contextual errors," can be minimized through changes in how doctors are trained, how medicine is practiced and quality measured, and in the ways patients assert their needs during visits. The aim of this book is to open a dialog between patients, physicians, policy makers, and medical educators, about a serious quality problem that has been overlooked and understudied.


1. Observing the Problem
2. Measuring the Problem
3. The Problem is Everywhere
4. What We Hear that Physicians Don't
5. Causes
6. Better Teaching, Better Doctors
7. Is Lasting Change Possible?
8. What We Can't Measure that Matters
9. Bringing Context Back into Care

About the author: 

Saul Weiner, MD, and Alan Schwartz, PhD, at Jesse Brown VA Medical Center and the University of Illinois at Chicago College of Medicine, have spent the last ten years studying how well physicians personalize care to their patients. Their work involving undercover actors and audio recording by real patients carrying concealed audio recorders has been published in Annals of Internal Medicine, JAMA - The Journal of the American Medical Association, BMJ Quality & Safety, The Joint Commission Journal of Quality and Patient Safety, and Medical Decision Making. They are also the founders and principals of the Institute for Practice and Provider Performance Improvement, Inc., which brings these techniques from research into practice.

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