Six Ways To Put The Patient Back Into Patient-Centered Care

Patient-centered care is an over-used, misunderstood, and oftentimes hypocritical phrase.

There. I said it. I know, that is a pretty strong statement, but it had to be said.

It has become a trendy phrase that gets thrown around regularly these days. But the deeper meaning - and how to truly attain it - is, at times, lost or misunderstood.

There can be many subtle barriers to patient-centered care. We may think that something is patient-centered, yet it is far from it.

"Patient-centered" indicates more than just the fact that the patient is the center of the equation. It is more than just having a focus on the patient. True patient-centered care manifests itself in many ways.

Here are 6 ways in which we can put the patient focus back into patient-centered care:

1. Patient-centered means that the patient has self-responsibility. This extends not only to decision-making, but to accepting the ramifications of those decisions as well. It also requires clinicians to not assume responsibility or ownership if and when the patient chooses not to do so. Sometimes, a patient will persist in abdicating their self-responsibility, even counter to our efforts to promote it. There is a time and a place for the word "no". This creates a healthy interdependence as opposed to a not-so-healthy codependence.

2. Patient-centered involves value being established by the patient. The patient will ask "What's In It For Me" and the answers need to be phrased consistent with this, in their context and terms. Our perceived value, as high as it might be, does not specifically correlate with their perceived value.

3. Patient-centered requires principles of adult education. Oftentimes, "patient education" really isn't "education". It is telling a patient what you want them to do, which is a far cry from true adult education. It does not involve telling or scolding. People do not learn by being told what to do - they learn by being involved in the process, in exploring, in establishing cause and effect relationships. Maybe the patient isn't making the link or seeing the relationship because of our lack of sound adult educational skills.

4. Patient-centered means removing paternalism - the "father knows best" mentality - from the equation. Clinical interactions can at times become more about the clinician's expertise or skills or guru status and less about the relevance of those skills to finding a solution for the patient. It is admittedly a subtle difference at times. Instead of "I know what's best for you", the conversation needs to become one of an exchange as equals, a partnership between clinician and patient.

5. Patient-centered means an active involvement of the patient in self care. Search engines have become incredible ways for a patient to access volumes of information that were unheard of a mere 2 or 3 years ago. The role of the health care provider can evolve into a mentor and guide, working alongside the patient to create solutions.

6. Patient-centered means that a patient has the right to choose their provider freely. This is perhaps the most important issue - a patient's choice. If we have arbitrary laws and regulations that limit this, then can we really say that the system is patient-centered?

True patient-centered care can exist but it requires a subtle transition in language, in clinician role, and in the systemic rules. If we can truly put the patient at the center of care - and not just use the phrase haphazardly or hypocritically - then good things will happen: for patients, for clinicians, and for the health care system as a whole.

Photo credits: james.thompson