Patient-centered care (as it is described by doctors) or person-centered care (the phrase-more frequently used in non-medical settings) is one of those concepts everyone supports–except when it comes to the details. On Nov. 8-9, I’ll be participating in a two-day symposium sponsored by the Samueli Institute aimed at breaking down the barriers between the medical and non-medical world and seeking evidence to show the benefits of patient (or person) centered care.
The conference, which aimed at health care professionals, will be held in Alexandria, VA. I’ll be delivering one of the keynotes, along with Carolyn Clancy, director of the Agency for Healthcare Research and Quality. The Samueli Institute is a non-profit dedicated to integrative medicine, optimal healing environments, the role of the mind in healing, behavioral medicine, health care policy, and military and veterans’ health care.
When I talk to hospital and nursing home administrators, they all say they want to do a better job focusing on the needs of their patients or residents. And many say they are doing it well. But often, they are falling short of true person-centered care. They are improving what hotel marketers would call the “customer experience” by adding amenities. For instance, a hospital recently profiled in The Wall Street Journal now serves wild salmon on its menu and has added ESPN to it cable listings.
Nothing wrong with that. Who wouldn’t want better food in the hospital? But that’s not patient-centered care.
That facility, Grady Memorial in Atlanta, is also teaching doctors to–sit down now–stop interrupting patients while they are talking. Now that is progress.
But letting a patient speak is still not person-centered. That requires another step–actually listening to what she is saying and making her and her family a real part of the care team.
In the end, it is all about control. It is about doctors asking patients about their goals–and paying attention to what they say–and sharing decisions with people who have no medical training.
This is not how doctors normally think. But it matters. Does a patient want to live as long as possible, or would she prefer to be pain-free even if it means giving up a few years? Does a patient want to take his chances with a high-risk surgery,even if the outcome could be death, or a very poor quality of life?
Does a nursing home resident want a breakfast at 7 :00AM, or 10:00? Who wants spiritual rather than medical care? Who wants both?
The answers, of course, differ from person to person. And that’s the point. This kind of care requires doctors, nurses, and social workers to take the time to get to know their patients and what they want.
That raises the question: Does patient- or person-centered care work? Does it improve outcomes? In the end, are people who participate in their own care decisions healthier? And because there is so much focus on the cost of health care these days, does it save money?
The Samueli conference will explore many of these questions. I’ll be interested to learn what experts in the field have to say.
Two thumbs up Howard!
Good to hear about your support of patient oriented care. It’s a long shot in the larger acute care arena, but if we- who serve patients in any way, can pause to listen to your message, we will be LISTENING to our patients and their loved ones! Never mind being rushed. I think healthcare providers have become maybe too outcome driven! And we will actually create a more-patient-oriented health care-plan (or patient-centered care environment). But if I may turn your attention to the process of care planning, which begins with the art of assessment skills. It’s right here where your message resonates with me mostly. We will indeed be advancing the most desired “individualized” care-planning that we were meant to be more focused on from the beginning when we see more subjectively. More client driven. No blame here. In fact, the health care industry has been so driven by “DRG” and now “ICD-9” outcome orientations; along with other regulatory factors weighing in so that providers can so easily loose sight of what you now remind us to reconsider. Providers can so easily be distracted by a diagnosis, or a generic “need,” rather than the actual indivual’s subjective needs. This is where we have to rightly divide the subjective and objective data carfeully. So many level of care choices depend heavily on diagnosis criteria, or are defined more by what chronic illness and with what co-morbidities exist, rather than the person’s response to a particular illness or group of symptoms. The cost and control of healthcare is the problem we face. No matter what drives the outcome however, a more patient centered approach begins with a more patient centered care plan! This applies to the approach we have to the patient more specifically. We must assess each patient from a more subjective date base. We must plan to care, before we care-plan. I applaud this topic, and I will continue to make the much needed effort(s) for each care-plan I do to be more individualized. Thanks again, for this reminder! It is people we care for, not plans, anyway, right?
Howard, I couldn’t agree with you more. I am looking forward to hearing about your experiences at the symposium. I am also glad to hear about the Samueli Institute, as my interests coincide. I was fortunate to be able to bring Qi Gong to my last SNF, and I hope to be able to influence other centers in offering a more rounded set of Western/Eastern, Medical/Non-medical options. Actively taking interest, control and responsibility for our own lives, with education and support is key. I have appreciated some TCM practitioners’ approach that fulfills the belief that each individual’s self perception and knowledge are at least as important as the “expert’s”, which ensures a truly interactive wellness visit. I appreciate your characterization of the provider as “coach.” Kudos and thank you!