Patient Involvement Key to Patient Centered Care.

The path to a better health care environment for patients starts with

1. engaging patients in decision-making,

2. encouraging dialogue between patients and physicians, and

3. using electronic health records (EHRs) as a collaborative communication tool in the exam room,

according to the authors of three separate viewpoint articles published June 11 in the Journal of the American Medical Association.


Patients have a responsibility to take part in care decision-making, according to viewpoint authors Mary E. Tinetti, MD, and Ethan Basch, MD, MSc.


In a separate article, Timothy J. Judson, MPH,  and Matthew J. Press, MD, MSc, examine the lack of patient engagement during care — particularly surrounding the barriers that “prevent patients and physicians from meaningful question-and-answer exchanges.”

On the patient side, a reluctance to ask questions — known as “white-coat silence” — can plague patients who fear “being labeled difficult,” taking “too much of the physician’s time” or the underlying “asymmetry of power” that exists between patients and physicians. Physicians are less likely to embrace dialogue due to time constraints or even competency challenges.


The authors suggest a few solutions to the dialogue dilemma. Encouraging patients to ask questions is a start, but needs to be part of a more fundamental reengineering of health care toward a patient-centered experience in which white coats provoke more open dialogue and less apprehensive silence,” write the authors.


A third viewpoint article reasons that EHRs in the exam room can facilitate patient-physician communication. The authors note that EHRs can help via electronic messaging, giving patient access to records, tools and test results that are otherwise difficult to obtain, and giving patients the ability to read over physician notes online post-exam which in turn provides a sense of control in their care.


Moving forward, the physicians need to communicate more with their patients while on patient’s side, patients need to get rid of their inhibition to ask questions about their care to their physicians.

via CardioSource – Patient Involvement Key to Patient Centered Care.

ESH/ESC publish hypertension guidelines: Lifestyle changes reduce BP!

The European Society of Cardiology and the European Society of Hypertension released Guidelines for Physicians to treat Hypertension (high BP). The joint guidelines are designed to reduce the morbidity and mortality associated with hypertension.

Worldwide, 1.5 billion people currently have high blood pressure, according to the World Health Organization.

Dr Robert Fagard, the chair of the ESH/ESC writing committee, reiterated that treatment decisions for patients should be dictated by their overall level of risk and a holistic approach to treatment should be advised by physicians.


Lifestyle changes for treatment!.


The new guidelines make a host of lifestyle recommendations for lowering blood pressure.

1. Salt intake:  The Guidelines recommend salt intake of approximately 5 to 6 g per day, in contrast with a typical intake of 9 to 12 g per day. A reduction to 5 g per day can decrease systolic blood pressure about 1 to 2 mm Hg in normotensive individuals and 4 to 5 mm Hg in hypertensive patients.

2. Lower BMI:  While the optimal body-mass index (BMI) is not known, the guidelines recommend getting BMIs down to 25 kg/m2 and reducing waist circumferences to <102 cm in men and <88 cm in women. Losing about 5 kg can reduce systolic blood pressure by as much as 4 mm Hg.

3. Exercise: Aerobic endurance training in hypertensive patients can reduce systolic blood pressure by 7 mm Hg.


Fagard said that physicians can typically give low/moderate-risk individuals a few months with lifestyle changes to determine whether they’re having an impact on blood pressure. They should be more aggressive with higher-risk patients, however, noting that drug therapy is started typically within a few weeks if diet and exercise are ineffective.


via ESH/ESC publish hypertension guidelines |