The good physician treats the disease; the great physician treats the patient who has the disease.
~ Sir William Osler, M.D.
Where do you meet the patient? Where do you meet the clinician? Is the playing field level, eye to eye, or is the power and decision-making imbalance clear for all to see? When reading and discussing this week’s blog, take some time to consider these basic questions – both from the clinician and patient perspective.
Patient-centered care. What’s in a term? Here is one accepted definition. According to the National Academy of Medicine, patient-centered care is:
Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
Seeing the word guide means just that – not a line drawn in the sand meant to lessen the influence of the physician and team, but meant to inform the shared decision-making process.
Stacey Chang (@Stacey_Chang) is the Executive Director of the Design Institute for Health, a collaboration between the Dell Medical School and the College of Fine Arts at the University of Texas at Austin. Reading about Stacey’s experience as he studied patient-centered care, it quickly becomes clear that patient is a limiting term.
In Beyond Patient-Centered Care, as Stacey wrote for the Dell Medical School blog, I learned about his experience studying the Swedish healthcare system. Chang shared that the University of Gothenburg’s Center for Person-centered Care (GPCC) defines things a bit differently. In fact, the GPCC refers to Person-centered vs Patient-centered care. The difference is more than academic.
The GPCC defines person-centered care as a true partnership between patient and healthcare professionals, where a personal health plan is mutually developed, agreed upon, and executed.
I don’t know about you, but this definition feels more complete and encompassing. We don’t even see talk about providing care, but instead focusing on a partnership developing and executing a personal health plan. This is meeting the person (patient) by looking at them in the eye versus creating distance and a paternalistic control.
Before going further, we should always keep in mind the real and critical differences between the clinician and the patient. Creating a partnership between a person (patient) and clinical team is not the same as saying everyone is equally informed or able to achieve desired outcomes – this applies from both the patient and the clinical perspectives. Control can be asymmetrical and all parties must keep this in mind as circumstances dictate.
Putting person-centered care into action comes in many forms – from elaborate game-changing steps to small pivots and everything in between.
The Patient-Centered Medical Home (PCMH) is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.
For more information, we discussed this model in 2014 with a #hcldr blog post by Steven Daviss, MD, DFAPA (@HITshrink): Patient Centered Medical Home (PCMH) and Behavioral Health Integration.
Another example comes from the very institution that William Osler, M.D. helped found, the Johns Hopkins University School of Medicine. Within Hopkins, the Armstrong Institute for Patient Safety and Quality has a focus on “Delivering patient- and family-centered care” as well as “Creating a culture that values collaboration, accountability and organizational learning.” You can check out the Institutes’ blog, Voices For Safer Care, to read more about their focus on patient-centered care.
A final example comes from great people and their passion to transform healthcare, one clinic at a time. The folks at Flip the Clinic, led by Director Whitney Bowman-Zatzkin (@MsWZ), are working to improve healthcare via collaboration between patients, clinicians, and all stakeholders. I’ve been fortunate to be included in helping them review the beta of their Flip the Clinic Playbook, a roadmap for going forward in their efforts.
Check them out! The bottom line here is the shared passion we see to meet the patient in healthcare via new ways that include collaboration, open communication, empowerment, and leveraging the best assets everyone brings to the relationship. These three examples are just touching the surface of what is possible.
Please join the #hcldr community of friends, peers, and collaborators as we work to make a difference, one idea and one action at a time. Join us on Tuesday, August 1, 2017 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:
T1: What does patient-centered care mean to you? Experiences?
T2: What, if any, are the risks of breaking down the walls between clinicians and patients?
T3: How are advances in technology facilitating patient-centered care? Examples?
T4: As a patient/clinician how can you facilitate the move toward patient-centered care?
Resources for Further Study
Andrews, John. “Biggest Obstacles to Patient-Centered Care? Coordination and Quality Measurement.” Healthcare IT News, January 16, 2017. http://www.healthcareitnews.com/news/biggest-obstacles-patient-centered-care-coordination-and-quality-measurement.
Chang, Stacey. “Beyond Patient-Centered Care?” Dell Medical School Blog, October 27, 2015. http://blog.dellmedschool.utexas.edu/2015/10/27/beyond-patient-centered-care/.
Christman, Todd. “Patient-Centered Care.” NATA, November 2, 2016. http://www.nata.org/blog/todd-christman/patient-centered-care.
Daviss, M.D., Steven. “Patient Centered Medical Home (PCMH) and Behavioral Health Integration.” Hcldr, October 11, 2014. https://hcldr.wordpress.com/2014/10/11/pcmh-and-behavioral-health-integration/.
“Flip the Clinic.” Flip the Clinic. Accessed July 31, 2017. http://fliptheclinic.org/about/.
Frances, M.D. “Patient-Centered Vs. Lab-Centered ‘Personalized Medicine.’” Huffington Post, July 24, 2017. http://www.huffingtonpost.com/entry/patient-centered-vs-lab-centered-personalized-medicine_us_597624bfe4b0940189700b94.
“GPCC – Centre for Person-Centred Care, University of Gothenburg, Sweden.” Göteborgs Universitet. Accessed July 31, 2017. http://gpcc.gu.se/english/.
“Health and Medicine Division.” Accessed July 31, 2017. http://www.nationalacademies.org/hmd/About-HMD.aspx.
Kakeeto, Mikael, Robert Lundmark, Henna Hasson, and Ulrica von Thiele Schwarz. “Meeting Patient Needs Trumps Adherence. A Cross-Sectional Study of Adherence and Adaptations When National Guidelines Are Used in Practice.” Journal of Evaluation in Clinical Practice 23, no. 4 (August 2017): 830–38. doi:10.1111/jep.12726.
Marshall, Mark Roger, and Christopher T. Chan. “The Evolution of Home HD – Meeting Modern Patient Needs” 189 (2017): 36–45. doi:10.1159/000450820.
Minemyer, Paige. “PCMH Programs Cut Costs and Improve Quality. Collaboration Is the Key to Their Success.” FierceHealthcare, July 11, 2017. http://www.fiercehealthcare.com/healthcare/report-pcmh-programs-cut-costs-improve-quality-but-collaboration-key-to-success.
Patient-Centered Primary Care Collaborative. “The Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization,” July 2017. https://www.pcpcc.org/resource/impact-primary-care-practice-transformation-cost-quality-and-utilization.
Smalley, Christine. “Telemedicine: Take a Lesson from Retail to Improve Patient Adoption.” MedCity News, July 31, 2017. http://medcitynews.com/2017/07/telemedicine-take-lesson-retail-improve-patient-adoption/.
“What Is the Patient-Centered Medical Home? (PCMH) | ACP.” Accessed July 31, 2017. https://www.acponline.org/practice-resources/business/payment/models/pcmh/understanding/what-pcmh.
Photo Credit: https://pixabay.com/en/doctor-baby-child-young-healthcare-870361/ as released under Creative Commons CC0.