Contextualized Care

Book author and CMS member discusses his latest research
By Cheryl England

When Saul Weiner, MD, an internist and pediatrician, was selected for a three-year program by the Robert Wood Johnson Foundation to train to be a researcher he made an interesting discovery: he noticed that while medical students were doing well at following evidence-based guidelines, they often overlooked the obstacles patients face when following a care plan. So the plan was doomed to fail despite adhering to the latest science. As a result, Dr. Weiner decided to focus on how physicians could better care for patients by taking into account the particular life challenges they face when planning their care, a process he termed “contextualizing care.”

Now, after a decade of groundbreaking work and many peer-reviewed publications, he and his research partner, Alan Schwartz, PhD, a cognitive psychologist, have brought all of their findings together in a book this year, titled “Listening for What Matters: Avoiding Contextual Errors in Health Care” (Oxford University Press). Chicago Medicine took the opportunity to learn more about the duo’s work.

CM: What do you mean by the term “contextualizing care?”

SW: It means considering the factors in a person’s life, such as their financial situation, that may prevent them from following an evidence-based care plan. For instance, if you have a patient whose asthma is getting worse, you, as a physician may prescribe an additional medication because that’s what good science tells you to do. But in reality, that patient may have just lost his job and is no longer able to afford his brand name inhaler. A better solution would be to switch him to a less expensive generic. All in all, there are 12 areas in patients’ lives—we call them “contextual domains” —that can impact their care, including their finances, competing responsibilities, social support, resources, and relationship with the healthcare provider and system.

CM: How did you perform the research?

SW: First, we trained and deployed actors to work as undercover patients, called “unannounced standardized patients.” Next, we invited over a thousand real patients to carry concealed audio recorders into their visits, all with participating physicians’ consent.

CM: What was your most surprising finding?

SW: We found it really interesting that providing patients with care that is tailored to their specific circumstances doesn’t take any longer than simply following guidelines, but it does lead to better outcomes and lower costs.

Dr. Saul Weiner is professor of medicine, pediatrics and medical education and vice provost for planning and programs at the University of Illinois at Chicago.