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27th Annual Families
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Plenary Sessions
Thursday, March 1
8:15-9:30 am
“Changing Organizational Culture to Support Relationship-centered Practice”
Anthony Suchman, MD, MA, FACP, Relationship Centered Health Care, Rochester, NY
Relationship-centered care (RCC) is a clinical philosophy and approach characterized by partnership and shared decision-making at every level: between patients and their clinicians, between members of the interdisciplinary health care team, and between the health care system and the community. While the clinicians’ communication and relationship skills facilitate such partnerships, an even more important factor is the nature of each clinician’s relationship with self and the capacity to be fully and authentically present to others.
The organizational environment has an important effect onthe nature and quality of care. All too often and without anyone’s explicit intention, the environment elicits behavior that is impersonal, hierarchical, and controlling—the very antithesis of RCC. So the next generation challenge in health care is to develop a practice of relationship-centered administration, fostering organizational environments that facilitate (rather than inhibit) relationship-centered care.
The very thought of organizational change on this scale may seem so daunting and hopeless that we shrink from taking even the first step. However, by examining the way we think about organizations and organizational change, we can discover a number of limiting assumptions and unrealistic expectations that evoke fear and defensiveness.
We can also identify an alternative perspective, informed by relationship-centered care and complexity, that offers fresh insights and new strategies. By showing the feasibility of change, it also offers us the hope we need to carry this work forward. Anthony Suchman, MD, MA, FACP, is a practicing physician, organizational consultant, and clinical professor of medicine and psychiatry at the University of Rochester. He studied patient-clinician relationships, medical decision making, physician satisfaction, and the spiritual dimensions of medical care. He has become known as one of the leading proponents of relationship-centered care.
After 15 years of academic pursuits, Dr Suchman became interested in health care organizations, particularly how the values expressed in administrative processes and in the behavior of leaders affect processes of care. He helped to found the Highland Physicians Organization and was its first executive director. He subsequently helped to establish the Strong Health Managed Care Organization and was its first CEO and chief medical officer. He also earned an MA degree in organizational change.
Currently Dr Suchman is working with clinicians, admin-istrators, and board members in health systems in the United States and internationally to advance the practice of relationship-centered care.
Friday, March 2
8:15-9:30 am
"Narrative Medicine from the Margins: Witness, Voice, and Vulnerability"
Sayantani DasGupta, MD, MPH, Columbia University
Narrative movements in medicine have given professional recognition to what was always intuitively known by patients and practitioners: that the heart of health care lies in stories. The illness narrative is a story co-created by teller and witness, a relationship entered into by the individual experiencing suffering and the health care provider charged with giving recognition to that suffering. Such narratives give form to what was once experienced as chaos, make public what was once private. However, the telling of such stories requires cultural and social access to the tools of narration—a facility with formal structures of English language and storytelling. Unfortunately, the stories of marginalized populations—children, people of color, gays, lesbians and bisexuals, immigrants, impoverished or imprisoned individuals—are often the narratives that are quite literally ‘lost in translation,’ since effective narrating implies the ability to both speak and have one’s intended message heard and interpreted correctly. How do we as health care providers learn to interpret untellable stories? How do we witness the voices of the most vulnerable?
Sayantani DasGupta, MD, MPH, is assistant clinical attending in pediatrics, as well as board member and faculty in narrative medicine at Columbia University. She is the author of two books, The Demon Slayers and Other Stories: Bengali Folktales; and a memoir of her time at Johns Hopkins Medical School, Her Own Medicine: A Woman’s Journey from Student to Doctor. She is the coeditor of a forthcoming anthology of women’s illness writing, Stories of Illness and Healing: Women Write their Bodies.
Saturday, March 3
8:00-9:15 am
“Primary Medical Care for Families Revisited: An Unorthodox Rearrangement of Old Ideas”
John Saultz, MD, Oregon Health and Science University
From the earliest days of family medicine, there has been disagreement about “family” as a central concept for our discipline. As we approach the end of our 4th decade as a specialty, we find ourselves in an era of turmoil and change unequaled since the decade of our birth. Our discipline has recently completed a comprehensive strategic plan commonly referred to as the Future of Family Medicine Project. This strategic plan calls for major changes to our clinical and educational models and national demonstration projects are now underway to begin implementation of this plan.
But this new model of care has relatively little to say about the care of family units. To what extent will our field remain committed to the care of families? How can the new model of care be developed in a way that respects our traditional focus on the family in family medicine? Is the care of families simply a part of personal, relationship-oriented care or does the new model need to be modified or clarified with this concern in mind? Can a family focus actually be enhanced by the development of team-based care? This presentation will outline how our past can serve as both a guide and a cautionary tale for family medicine’s future and how the future of American medicine may depend on the choices we make in this process.
John Saultz, MD, is professor and chair at the Department of Family Medicine at Oregon Health and Science University (OHSU). From 1986 to 1994 Dr Saultz was the family medicine residency director at OSHU. He is currently chair of family medicine and assistant dean for primary care of the OHSU School of Medicine. He also has served as director of Oregon’s statewide Area Health Education Centers (AHEC) Program from 1995-2006. In 2003-2004, he was named an STFM Bishop Fellow.
Dr Saultz is a diplomate of the American Board of Family Medicine, a fellow of the American Academy of Family Physicians, and a member of the Society of Teachers of Family Medicine.
Dr Saultz is a past president of the Association of Family Medicine Residency Directors and the Oregon Academy of Family Physicians. He served on the Residency Review Committee for Family Practice from 1999-2005 and on the Accreditation Council for Graduate Medical Education from 1992-1998.
Dr Saultz is the author of three books and more than 90 journal articles and book chapters. His current research interests include continuity of care in the doctor-patient relationship, medical decision making, and the future of family medicine.