Written by Dr. Keith Thompson, OntarioMD Physician Peer Leader
It was Dr. Ian McWhinney who formulated the concepts around patient-centric care in a primary care context. Patients will present to their primary care provider for one of four common reasons according to McWhinney’s Theory:
1. The Limit of Tolerance: the patient cannot stand the pain or itch or symptom that is interfering with their daily lives;
2. The Limit of Anxiety: the patient cannot cope with the worry about their condition or whether the symptom is serious to potentially cause deeper harm;
3. The Ticket In: the patient schedules an appointment for one condition, but their real intent is to ask about something else that is bothering them;
4. Administrative Duties: the patient needs a note or form, a medication refill or lab testing;
Being reminded of these reasons for engagement by patients is important now more than ever. Our primary care ecosystem is increasingly relying on information and communication technologies, remote monitoring, and digital health data all allowing for fewer in-person encounters and more virtual visits, both synchronous and asynchronous. The challenge is how do we maintain relationships with patients while using virtual care technologies, and still address the underlying concerns of patients that are causing them to seek medical attention.
My advice is to take a pulse regarding the patient needs outlined by McWhinney’s Theory and how you may measure up:
1. Ask your patients at the end of an encounter about how they felt about the session.
2. Leverage your data on office visits and bookings access as well as Ontario Health-Health Quality Ontario surveys on office assessment, accessibility and quality improvement
Check out Health Quality Ontario’s Advanced Access and Efficiency Workbook for Primary Care and the Quality Improvement Guide
3. Create your own hybrid model of care that matches the type of patient encounter (in-person vs. virtual) to the needs outlined in McWhinney’s Theory. Which method is best for meeting those needs or is there a difference?
In Memoriam – Randy Filinski
This blog post is in memory of one of OntarioMD’s (OMD) inaugural Patient Leaders, Randy Filinski. Randy passed away on May 28, but leaves a legacy for us at OMD of passion to provide patient-centred care for Ontario patients. Randy was not only an eloquent speaker, but lived the patient health care journey firsthand. He was a champion for patient advocacy along with his fellow OMD Patient Leaders, was truly a pleasure to work with, and he will be greatly missed.
Randy, thank you for your vision and the time you gave OMD to inform our digital health priorities. Your time with us was far too short. We will be forever changed by your influence, your advocacy, and your passion for better patient care in this evolving virtual care landscape.
Since late 2020, Patient Leaders have become part of our OMD family and provide us with the important patient lens to help us stay focused on providing care that will address patient needs, match physician workflows and technological advancement. Improving care involves quality improvement, collaboration, communication and breaking down silos. The Patient Leader Program provides the critically needed patient voice to serve Ontario patients. This program is important to OMD’s strategy to provide physicians with the support and tools they need to provide data-driven, quality-based health patient-centric care and to activate patients to help reach that goal.
