Bringing Patient Perspective to the Forefront of High-Value Care
To the Editor:
Erath and colleagues make a strong case for integrating high-value care (HVC) into preclinical medical education.1 We agree that cost-conscious care should be taught from the beginning of medical school, and it should encompass broad health systems science topics as well as the granular costs of laboratory and imaging studies. However, the authors fail to consider the full meaning of “value” in the context of patient-centered care. Value is more than cost and the structure of health care systems; it is an embodiment of the outcomes that matter to the patient divided by the cost of their care.
After our school’s participation in the Students and Trainees Advocating for Resource Stewardship (STARS) Program 2019,2 we learned that HVC is an evidence-based framework that strives to provide the patient with the best individualized care. To identify the unique health goals of each patient, the physician must use open-ended questioning and shared decision making to devise a personalized health plan. Clinical skills courses in the preclinical curriculum should teach the patient’s perspective of value as an integral interviewing skill. This ability to collaboratively identify a patient’s values and health goals builds upon the foundations of preventive and lifestyle medicine, as measures such as diet, exercise, and risk behavior modification are typically of low cost, but require motivational interviewing and patient engagement to deliver long-term value.
In the context of a physician–patient relationship built on empathy and trust, clarifying health goals is key to reducing health care waste. Contextualizing value within the physician–patient relationship can transform a medical student’s nascent professional identity and serve as a platform for the application of value at the bedside during the ensuing clinical training years. Therefore, curricula with a dual emphasis on costs of care, as the authors have emphasized, as well as outcomes which matter to the patient, are crucial to developing competencies of HVC in medical education.
1. Erath A, Mitchell M, Salwi S, Liu Y, Sherry A. The sooner the better: High-value care education in medical school. Acad Med. 2019;94:1643–1645.
Copyright © 2020 by the Association of American Medical Colleges
2. Cardone F, Cheung D, Han A, et al. Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: A descriptive evaluation. CMAJ Open. 2017;5:E864–E871.