Health Advocacy and Social Accountability in Family Medicine

Core Responsibilities for Health Advocacy

• Family physicians have a fundamental responsibility to influence community health status beyond individual patient encounters, including identifying and responding to social determinants of health, modeling healthy lifestyle practices, and participating in community education projects, as recommended by the American Academy of Family Physicians 1, 2
• Modeling healthy lifestyle practices as part of professional responsibility, as recommended by the American Academy of Family Physicians 1, 2
• Participating in community education projects to extend health promotion beyond the clinical setting, as recommended by the American Academy of Family Physicians 1, 2

Implementing Social Accountability Through Patient Partnership

Direct Care Level

• Treat every patient with dignity and respect by incorporating their cultural beliefs, values, and preferences into care planning, as recommended by the American College of Physicians 3, 4, 5
• Hold confidential conversations in private settings and use interpreter services when needed, as recommended by the American College of Physicians 4, 5
• Ask patients how they prefer to be addressed and if they want family members involved in discussions, as recommended by the American College of Physicians 4, 5
• Provide education materials at or below 5th-grade reading level in the patient's language, as recommended by the American College of Physicians 4, 5
• Tailor education to the patient's cultural background and level of understanding, as recommended by the American Academy of Family Physicians 1, 2
• Listen without interruption and explain what you're doing throughout encounters, as recommended by the American College of Physicians 4, 5
• Empower patients as active partners in their own care by encouraging them to accept responsibility for managing their health while working collaboratively with the healthcare team, as recommended by the American College of Cardiology 6
• Involve patients in setting treatment goals and evaluating their own progress, as recommended by the American Academy of Family Physicians 1, 2
• Use mutual goal-setting interventions that have demonstrated improved patient outcomes, as recommended by the American College of Cardiology 6
• Assess patients' readiness to learn, comprehension, and ability to carry out treatment plans, as recommended by the American Academy of Family Physicians 1, 2
• Utilize "teachable moments" during patient encounters, as recommended by the American Academy of Family Physicians 1, 2

Organizational and System Level

• Engage patients and families as advisors in quality improvement and system redesign initiatives, as recommended by the American College of Physicians 7
• Establish patient and family advisory councils for feedback on care processes and physical environment, as recommended by the American College of Physicians 7
• Invite patients to participate in root cause analysis of medical errors and quality improvement activities, as recommended by the American College of Physicians 7
• Include patients on committees addressing performance measurement and clinical guidelines, as recommended by the American College of Physicians 7
• Solicit patient feedback for major decisions like electronic health record purchases, as recommended by the American College of Physicians 7
• Partner with patients in health professional education by moving beyond isolated initiatives to coordinated programs that develop authentic partnerships at institutional levels, as recommended by the American College of Physicians 7, 8
• Involve patients in curriculum planning and development, as recommended by the American College of Physicians 8
• Have patients help orient new staff and evaluate patient education materials, as recommended by the American College of Physicians 7

Policy and Advocacy Level

• Advocate at local, state, and national levels to improve health care policies, as recommended by the American College of Physicians 7

Common Pitfalls to Avoid

• Do not confuse respect for patient preferences with "giving in" to inappropriate requests, as recommended by the American College of Physicians 3, 4
• Recognize that low health literacy affects 88% of adults and creates barriers to engagement, as recommended by the American College of Physicians 4, 5
• Avoid episodic or isolated advocacy efforts, as recommended by the American College of Physicians 7