Patient Centered Decisions

All clinicians know that we must carefully listen to our patients and put into context all circumstances occurring around the patient that can affect their care; this is the "context of care". Domains of the context of care can include emotional or socioeconomic state, competing responsibilities and spiritual beliefs. However, busy clinicians often miss contextual signals. If the patient did not respond to therapy, was it because they couldn't afford their medication? Was the clinician aware of their financial difficulty? A recent study demonstrated the importance of appropriate contextual assessment.   In reviewing 400 internal medicine clinic visits, it was found that appropriate care was given to common clinical problems 73% of the time IF adherence to best practice was all that was required. However, it was only appropriate 22% of the time in patients who demonstrated contextual factors that required attention. Not only do we need to choose our interventions from evidence-based literature, we need to embed that into the patients' context to deliver high quality care.