A leader and innovator in research on patient-centered care, Dr. Leana Wen will share her perspectives on what patients and providers can do to work more effectively together to achieve their shared goal – better health and outcomes. She will be joined by Sonia Millsom, VP of Best Doctors, who will discuss how optimizing care and controlling costs are within reach for today’s patient. The presenters will finish with live questions from the audience.

1. Becoming Better Advocates for Your Health
Tuesday, July 22, 2014
2:00pm – 3:00pm

2. 2
Speakers Today
Sonia Millsom, MPH
Vice President, Client Strategy
Leana Wen, MD, MSc
Director, Patient-Centered Care Research
Department of Emergency Medicine
The George Washington University

3. 2 stories
 #1: Jerry
 #2: May

4. The problem
 Rising cost
 Unnecessary tests
 Growing disconnect
 More tests… but fewer answers

5. Pressures and consequences
 Lots of patients, little time
 “Defensive medicine”
 Overreliance on technology
 Medical training
 Misapplication of checklists
 “More is better”

6. Misdiagnosis
 100,000 deaths from medical errors per year
 Most medical errors are errors in diagnosis
 80%+ of diagnoses are made based on history
 10 seconds before the doctor interrupts
 What does this mean for diagnosis?

7. What can be done
 Healthcare system needs to be reformed
 Who is the system?
 We cannot wait
 “All medicine is personal”

8. The big question…
 How do we do this?
The patient’s
perspective
The provider’s
response &
responsibility

9. #1. Establish an active
partnership
 Set expectations
 Partner in your
decision-making
 Ask to share in the
thought process
 Set expectations
 Be transparent
 Involve patients in
decision-making
 Don’t assume
 Explain your thought
process
Patients Providers

10. #2. Focus on the diagnosis
 Know why it’s
important
 Ask for:
◦ Most likely dx
◦ Other possibilities
 Assure your doctor,
OK not to be 100%
sure
 Explain why it’s
important
 Provide every pt with:
◦ Working dx
◦ Differential dx
 It’s OK not to be 100%
sure
Patients Providers

11. #3. Listen
 Tell a good story
◦ Story, not symptoms
◦ Begin at the beginning
◦ Use your own voice
 Come prepared
◦ Write it down
◦ Practice
◦ Bring an advocate
 Really listen
◦ “No questions asked”
◦ “With our whole being”
◦ Beyond the chief
complaint
◦ Will save time
 Encourage preparation
Patients Providers

12. #4. Understand every test
ordered
 Ask about dx before
tests are done
 Understand why a test
is being ordered
◦ What is it looking for?
◦ What are risks?
◦ What are alternatives?
◦ What happens if neg?
 Explain dx
 Ask yourself, for every
test:
◦ How will it change
management?
◦ Do I need it?
◦ How do I explain
risks/benefits?
Patients Providers

13. Will patient-centered care have an impact?
 Reduce:
◦ Unnecessary tests
◦ Cost
◦ Misdiagnoses
 Improve:
◦ Patient experience
◦ Physician happiness
◦ Healthcare system
 Right thing to do for our patients

14. Conclusions
 Lots of pressures leading to less-than-ideal
healthcare system
 We can make a difference, today
 Healthcare reform starts with all of us
 Final follow-up

15. Leana Wen, MD MSc
George Washington University
www.DrLeanaWen.com
www.whendoctorsdontlisten.com
@DrLeanaWen
Best Doctors, July 2014

16. 16
Nearly one-third of the $2.7 trillion spent
each year on healthcare in the U.S. is
considered to be wasted dollars, according to
the landmark report “Diagnostic Errors: The Next
Frontier for Patient Safety.”
Cost Implication of Diagnostic Errors
“Healthcare System Wastes Up to $800 Billion a Year,” Reuters, Oct. 26, 2009.
Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press, 2013.
Under-diagnosis, over-diagnosis and misdiagnosis contribute to wasted
healthcare dollars.

17. 17
Survey of Patient Experience with Preventable Medical Errors
Has a preventable medical
error been made in your own
care, or that of a family
member?
Did the error have serious,
minor or no health
consequences?
34%
1%
65%
Yes
No
Don’t
Know 3%
10%
21%
Serious health
consequences
Minor health
consequences
No health
consequences
Kaiser Family Foundation – 2004 - National Survey on Consumers’ Experiences with Patient Safety and Quality Information

18. 18
Challenges Facing Employers
Reduce direct and
indirect costs associated
with workplace health
challenges, including
short- and long-term
disability
Develop ongoing strategy
that fit current channels of
communication and strategy
Reduce costs
associated with absence
due to illness, estimated
at 2-3x more than drug
claims
Reduce risk of
misdiagnosis,
unwarranted surgery,
unnecessary drugs
and associated costs
Improve employee
attraction, satisfaction
and retention

19. 19
Diagnostic Accuracy and the Triple Aim
Minimize the costs of
unnecessary
hospitalizations,
medications, treatments
and surgeries
Improve diagnostic and
treatment accuracy through
expert reviews of complex
and critical care cases
Provide virtual access to world-renowned medical experts to
confirm optimal clinical pathway
Better Member Experience

20. 20
Best Doctors gave her confidence in her medical decision and
enabled her to become an empowered healthcare consumer.
“You are at risk for developing breast cancer.”
The Impact of an Expert Second Opinion
Let’s wait,
watch and see
what happens.
Try a hormone
therapy to
reduce your risk
of developing
breast cancer.
Remove the
breasts to prevent
the development
of breast cancer

21. A. 13% B. 45% C. 75%
WHAT’S THE CHANCE THAT
YOUR TREATMENT PLAN
NEEDS CORRECTING
FIND OUT…
IT MATTERS

22. 22
Questions?
www.bestdoctors.com