I mentioned that I attended a conference a few weeks ago of the Institute for Healthcare Improvement, where doctors thought about how to reinvent their own clinical practices. The conference was not classic CME (continuing medical education) in the sense that they were not, for instance, learning that this drug was better than that drug for diabetes, or that this device was better than that one for a failing heart. They were addressing how they organize their practices and deliver the care to make it both more efficient and higher quality. And they were encouraged to think about being a doctor—or a patient—in a way they had perhaps not thought about it for some time.

In the big hallway in the convention center (this was Texas, so the hallway was indeed big), conference organizers put up lip charts and invited docs to scrawl their responses to three key questions. People in politics and policy circles are so busy drawing up models and plans and simulations for health care reform, they sometimes forget what the docs may have to contribute. So here are some of their answers from those flip charts, a peek into the minds of caregivers who care.

I'm not listing all of them—but the topic that came up over and over and over again in various forms was communication. And in a health care system where doctors are often pressed to keep office visits short, communication can be less than optimal.

When you or a family member is a patient, what matters most to you?

• Communication with attending staff. Re: care; planning for future-next hour, next day, discharge; getting information early and not after the fact.
• Being "heard" and the opportunity to talk.
• Getting an answer I understand.
• Knowing the health care providers/support staff care about me or my loved ones.
• Eye contact from care givers: touch.
• Getting to participate in my own health care decisions.
• Information in writing. The ability to review key points.
• Be compassionate and listen to MY story.
• Not feeling "judged."
• Not feeling rushed!
• IT systems that talk to each other.
• Relate my health needs with what is personally important to me...i.e. being able to travel, staying active/healthy for my grand children, etc.
• That I don't fall through the cracks when the different health care teams don't speak to each other.
• Right diagnoses, one provider to direct the care, knowledge safe alternative to traditional medicine.
• That someone will CARE about what happens to me.
• Honesty.
• Not running late!
• I want to feel like I don't have to be on guard second guessing the orders, feeling like I am the only one with a sense of urgency and having to be vigilant for mistakes.

How do you renew your energy and passion for patient care?

• Conserve my energy by 1) recognizing my limits 2) Maintaining a life, as well as a practice, 3) Recognizing I cannot "cure all ills." Passion: time to recognize patients as people, with past and futures and value, not just decisions or management problems. Go to educational events to get perspectives different from mine.
• Sharing and encouraging sharing the personal stories—we are societal creatures, let's get it all out in the open.
• Engaging with the reality as experienced by the patient—identifying the gaps between the patient safety measures possible and the experience reality and resulting in to address the issue.
• As a general internist, demographics are in my favor. The population is aging and we are the experts in caring for this growing population.
• Art work and creative writing—as well as hiking/backpacking—total rebirth rejuvenation.
• By listening.
• Every time I am or my family is a patient I have either a good, bad, or mediocre experience. I want more of the good and want to improve the bad or mediocre ones.
• It seems to happen too infrequently but when I can get into another's life story and connect it with mine, whether it is about joy or simply being "broken," the bond is there and I go away...thankful
• I remember the words of Tom Marshall: "General Practice is the best job in the world—you get paid for talking to your friends".
• I sing.

What are your thoughts about WHAT we need to reinvent about primary care and HOW we can reinvent it?

• Stop seeing primary care givers as "jack-of-all-trades" and emphasize that we are in fact, masters of care management for our patients. Educate practitioners so we can be good patient care managers and educate our specialist colleagues for our value for patients and for them also.
• Primary care does not need to be "re-invented." We have a good product. We practice in a toxic environment. We have to gather up the tools and create around us the structures that allow us to do our job. "Get our house in order-model the behavior-guide our colleagues."
• Mash tents around the country with affordable care for all.
• Remember that behavioral health is primary care—too often this is left completely out of the thought process in planning and development.
• Demand payment for services rendered.
• Primary care is the foundation of all health care. It is where the patient gets the most care.
• Need to "re-invent" mechanism of sharing innovations that we develop with others. We have developed many systems to provide care of chronically ill patients, but aren't focused on writing/publishing or presentations. Therefore, no one knows to come to us and ask about our processes that are yielding results far better than large systems who often have staff to write/publish/speak.
• I think Dr. Douglas Eby summed it up well: We cannot improve on a process if it is fundamentally flawed. We make a huge assumption that our current healthcare delivery system is the correct one. We really need to take a look at the process and determine if our starting point is correct.