Six Ways To Stifle Patient-Centered Care

It has become one of the most oft-used and perhaps most hypocritical phrases in health care: patient-centered care. This usually goes hand-in-hand with the concept of patient autonomy. These are two buzz phrases that have lost much of their true meaning.

Clinicians like to believe that because the patient is the hub of the assessment and treatment paradigm, that this makes the care “patient-centered”. But when you look more closely, patient autonomy is stifled by some subtle (and not-so-subtle) issues. It could be the level of interaction with the patient, the attitudes of the clinician, and even the health care system itself. They all become significant limiters to patient autonomy.

Here are six ways to effectively stifle patient-centered care.

1. Limit a patient’s choices. This starts from the moment that a patient enters the US health care system. Depending on the state legislation, or the payer, or the professional turf battles being waged, the patient does not have an open market or, effectively, the right to choose their provider freely. A patient will find countless barriers along the way. In this day and age, with access to tremendous amounts of health care information, isn’t this something that the consumer could decide readily on their own with minimal legislation? And would making that decision not make their own care inherently more “patient-centered”?

2. Ask the patient for goals – and then ignore them. Or, better yet, don’t ask them at all. Should patients not be defining the goals of their care? But how often do we see the clinician defining the goals because they are the “expert”? The roots of paternalism can be found here.

3. Telling the patient is not educating the patient. “Telling” and “educating” are often confused in the clinical realm. Clinicians often believe that just because they have given the patient a long explanation that they have provided “patient education”. But true education is an active process that involves patient participation.

4. Make the patient a passive participant. It can be done via passive approaches to care when patients come in to the office to be “fixed”. Even if they go home with a home exercise program, they may immediately attribute changes – be they favorable or otherwise – to the passive treatment. Making a patient passive prevents them from having true ownership of their problem – and its solutions.

5. Think in terms of “compliance” and “adherence”. How often will we hear clinicians tell patients that their success is related to them being “compliant” with their program, or in “adhering” to the program? In many ways, this promotes an “us versus them” mentality. The patient needs to understand the cause-and-effect relationship experientially. This will allow them to truly engage in effective self care.

6. Don’t provide mentorship – just fix the patient. So many clinicians are trained as “fixers”, and they derive great satisfaction is doing so. But does that truly promote patient autonomy and patient-centered care at the most elemental level?

This is just a smattering of ways to stifle patient-centered care. Fortunately, they all have remedies. We can all aspire to improving patient autonomy and making sure that we are creating an environment in which true patient-centered care exists successfully.

Are you guilty of any of these in your clinical practice? What could you do today to make your clinical care truly more patient-centered?

Photo credits: mtsofan