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Are We Providing Patient-Centered Care?

Providers and Patients

There are many definitions of "patient-centered care" or "shared decision making" floating around. But most agree that it ideally includes certain aspects such as:

  • Consideration of the patient's preferences and needs
  • Integration of care through the teamwork of all providers involved
  • Respect for the non-medical needs of the patient and family
  • The patient's physical comfort
  • Free flow of communication among the patient, family members and medical team members

When I first heard of patient-centered care, I was somewhat perplexed. It reminded me of my own situation when I was 12 years old and had just been found to have a chronic medical condition. Our family internist sat down with me and my parents and explained that this was a problem that I would have for the rest of my life. He told us that there would be ups and downs, but that it was manageable. He went over the treatment options and asked what we thought would work for us. I have always considered that situation to be an example of patient-centered care.

Since then, there have been two big changes. The first change is the formation of care teams working together for the benefit of the patient and family. This has been a great help, but at times someone tries to force members of the care team on the patient. When that happens, we start to negate the positive effect of the team. The patient's perspective always needs to be considered. The second change is the free flow of information found online. Half of patients, both old and young, have already looked up their provider's credentials on the Internet before their first visit. Sometimes the patient will get false or dangerous information about either their provider or their ailment. This information must not be brushed aside, rather explained why it is not correct or appropriate for their condition. Then the patient should be directed to good, evidence-based care websites for more information. The Internet can be an ally in the patient care, almost like a team member when used correctly.

Physical comfort of the patient does not mean just giving a pill. Physical comfort is better reached by considering and helping patients with their social, emotional and spiritual needs. Most people can survive the physical discomfort if their emotional discomfort is adequately addressed.

One of the questions that I have not seen adequately answered is what happens when the patient has multiple problems that may or may not overlap. What if a woman has diabetes and congestive heart failure and is then found to have breast cancer? Does she have three different care teams? One care team is very nice, but she might find three different care teams to be annoying or overwhelming. And how do the care teams efficiently communicate with each other?

The biggest question is how true patient-centered care is paid for. Recent studies have shown that for every hour a non-procedural provider spends with patients, he spends two hours on the computer. Remember, that the fee schedules for all non-procedural providers were set well over 20 years ago, when computers were seldom used in patient care. Non-procedural providers have been forced into large clinics, which, unintentionally, can be very cold places that fall short of true patient-centered care.

Eventually, we will achieve true patient-centered care, but we often try to move too quickly on good ideas and do not first build adequate infrastructure. In this case the infrastructure is solid communication. Why are providers spending more time on the computer than they do seeing patients and addressing their needs? Are they reporting things to the government that will really make a difference? Are they sharing information? Why don't we work on getting computers to automatically pull out the information needed? Let's work on interconnectivity. Let's only put needed information in a chart. Technology should be the provider's friend.

If we can't truly streamline things to the point where each provider spends more time face to face with a patient than he does on the computer, I would rather go back to my family internist. He delivered excellent care!

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