Listening for What Matters: Avoiding Contextual Errors in Health Care

The best clinicians take into account the life challenges of their patients when planning their care, a process Drs. Weiner and Schwartz refer to as "contextualizing care." Failures to contextualize care, when they results in care plans that seem appropriate from a narrowly clinical perspective but are nevertheless unlikely to achieve their intended aims represent "contextual errors." Prescribing a medication a patient cannot afford when a less costly alternative is available would constitute such an error. Drawing on two decades of research including analysis of nearly 10,000 audio recorded medical encounters, the authors document an unmeasured dimension of quality: the extent to which clinicians attend to patient context, and its substantial implications for health care outcomes and costs. Listening for What Matters provides a comprehensive overview of research and quality improvement efforts to address the problem of contextual error. This second edition has been revamped and updated to include studies testing clinical decision support tools in the electronic medical record, medical student and resident trainee educational interventions, and an audio-recording based quality improvement program within the Department of Veterans Affairs. This book is a must-read for physicians, other health care professionals, policymakers and administrators, medical students, and medical educators.