A New Focus on Patient-Centered Care
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A recent article in the New York Times discussed a new approach by some doctors toward a more "patient-centered" approach in an effort to improve the quality of health care. The article included an interview with Dr. Donald M. Berwick, who is a Harvard pediatrician and the president of the Institute of Healthcare Improvement in Cambridge, Massachusetts.
Dr. Berwick explained that this "patient-centered" approach would require shared decision-making, meaning that on occasion, patient preference would be more heavily weighted than evidence-based care. In addition, medical records would belong to the patients, not the clinicians, and family members would be an integral part of health care processes and services.
Here is a short excerpt:
Q. Do you think “patient-centeredness” exists in current health care practice?
A. If you are interested in quality, you have to be interested in patient-centeredness. Good doctors and nurses do try mostly to focus on every patient as an individual. But we have built a system around clinicians that makes it impossible to customize care the way it needs to be. We don’t have a standard of services or processes that are comfortable for patients. We have built a technocratic castle, and when people come into it, they are intimidated.
Patients keep having to repeat their name because the system has no memory. We dress them in silly-looking gowns. We give them the food we make instead of the food they want. We don’t let them look into their medical records unless they have permission. Health care keeps telling patients the rules instead of asking patients about their individual needs. What is said is, “This is how we do things here,” not “How would you like things done?”
People get accustomed to this. They are trained to be passive, and passivity is not a good idea. Studies have shown that people who are trained to be proactive do better and feel stronger. They have more pride and trust in their own capabilities.
When you make someone helpless, in a funny way you make them sicker, even if all you cared about was just the body.
Dr. Berwick went on to discuss the conflict between treatments a patient may want, and treatments that are recommended. Dr. Berwick explained that this conflict must be resolved through a better exchange of information between the doctor and patient.
Not only does Dr. Berwick believe that this approach benefits patients, but he also feels that it would be a more rewarding way to treat from a caregiver's perspective.
I actually think the mode I am counseling would be more satisfying or joyous for caregivers. Not all of the time or always, but it would be a better place to be. You would be putting yourself at more of a level with the patient, as more of a peer. And you wouldn’t have to carry on as if you were mythical. Medicine is imperfect and doctors know that.
The bottom line, Dr. Berwick says, is that patients need to know what is happening to them. Patients need to take a proactive approach to their healthcare in order to get the best treatment available to them. Be prepared with questions and a companion to advocate for you if you are unable to do so yourself. Dr. Berwick says that if your doctor or nurse is not listening to you, then you should find someone who will. For information about finding the right healthcare provider, click here.