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Supplement: The Future of Generalism in Medicine |

Processes for Effective Communication in Primary Care

Saul J. Weiner, MD; Beth Barnet, MD; Tina L. Cheng, MD, MPH; and Timothy P. Daaleman, DO
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From the University of Illinois at Chicago and the Veterans Affairs Midwest Center for Health Services and Policy Research, Chicago, Illinois; University of Maryland School of Medicine and Johns Hopkins University, Baltimore, Maryland; and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.


Acknowledgments: The authors thank Simon Auster, MD, JD, for many shared insights and for comments on drafts of the manuscript that led to substantive changes. They also thank Greg Makoul, PhD, for suggestions incorporated into the section on provider–patient communication.

Grant Support: By the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Saul J. Weiner, MD, University of Illinois at Chicago, 840 South Wood Street, M/C 718, Chicago, IL 60612; e-mail, sweiner@uic.edu.

Current Author Addresses: Dr. Weiner: Departments of Medicine and Pediatrics, University of Illinois at Chicago, 840 South Wood Street, M/C 718, Chicago, IL 60612, and The Midwest Center for Health Services and Policy Research, Jesse Brown Veterans Affairs Medical Center, R&D (MC 151), 820 South Damen Avenue, Chicago, IL 60612.

Dr. Barnet: Department of Family Medicine, University of Maryland School of Medicine, 29 South Paca Street LL, Baltimore, MD 21201.

Dr. Cheng: General Pediatrics & Adolescent Medicine, Johns Hopkins University, 600 North Wolfe Street, Park 392, Baltimore, MD 21287.

Dr. Daaleman: Department of Family Medicine, University of North Carolina at Chapel Hill, CB #7595, Manning Drive, Chapel Hill, NC 27599-7595.


Ann Intern Med. 2005;142(8):709-714. doi:10.7326/0003-4819-142-8-200504190-00039
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Health care in the United States can be a fragmented and depersonalized experience. Many patients find themselves in a nomadic environment, often shuttling among physicians who rarely communicate with each other, and have no single provider who is well informed about their overall care (1 - 3). Not surprisingly, patients, health care providers, and purchasers all express widespread dissatisfaction with a system that, while costly and technologically advanced, performs poorly on many measures of quality (4). In this supplement, Stille and colleagues (5) review the evidence on interventions to coordinate care and reach consensus on the following points: the generalist should be the hub of care; generalists and specialists must collaborate more closely; care should be delivered by teams; patients and their families should be part of those teams; and information technology is critical for tying together the health care system. Not to overstep current evidence, they conclude that further work is needed to identify the elements of coordination that improve health outcomes.

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Figure.
Conceptual framework for communication with and without the obstacles to whole person, integrated patient care.

*Assumptions: providers are technically well trained, and they support the goals of whole-person, integrated patient care. EHR = electronic health record.

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