A Physician Tells All: What Patient-Centered Care Should Mean Today
Posted April 3, 2014
In certain contexts, the concept of “patient-centered” is misunderstood today, both by physicians and care teams, as well as from a patient’s perspective.
Physicians can see the patient-centered approach as reflecting just what the patient wants. And just as common, patients can interpret the phrase as suggesting that the doctor should do whatever the patient or caregiver wishes.
“That’s not what patient-centered care is about,” explains Dr. Nicholas Bennett, Medical Director at the Division of Pediatric Infectious Diseases and Immunology at the Connecticut Children’s Medical Center.
“When a patient expects the doctor to do whatever they want, in my mind that is patient-led care: the patient is the customer and the doctor is just a provider.”
Dr. Bennett compares the idea of patient-led care to a contractually driven encounter. This provider-patient experience is not what medicine should be, or what patient-centered care is about.
True patient-centered care is when you practice medicine, basing it on the entirety of a patient.
Patient-centered encounters take into account various aspects of where a patient is coming from, including individual concerns, expectations, and their level of understanding. “This is very different than the disease-focused approach or the cookie cutter and/or textbook approach expected to work best for a disease. That’s not always what is best for the patient,” explains Dr. Bennett.
For Dr. Bennett, looking at patient-specific information involves a three-pronged approach he has deemed Discover, Validate and Address, although the medical visit may require going through that cycle more than once.
From the doctor’s perspective, listening is invaluable when it comes to true patient-centered care.
“Sometimes listening is not just being there, sitting passively listening. Sometimes it is letting someone speak, and letting someone tell it in her own words. It also may mean giving them the permission to speak,” says Dr. Bennett. For example, if a physician can sense that a patient feels rushed, the physician can take a seat in order to give a non-verbal signal that the patient can relax and tell their story.
The discovery phase is a crucial one for a physician to uncover what’s really going on. If a patient is not adherent to medicine they were prescribed, perhaps its not just because they don’t want to take their medication—perhaps there is something larger at play. Asking patients and/or caregivers, “Is there anything else you want to talk about today?” goes a long way during the discover portion of an encounter.
Patient-centered care not only involves discovering what a patient believes, but it means recognizing that viewpoint, whether a physician believes it is right or wrong.
“The patient may have a concern, and even if you don’t necessarily agree with it, acknowledge the concern from their point of view.” Many times caregivers come to a doctor’s visit alongside loved ones, bringing information or opinions they’ve gathered beforehand. Because the doctor and patient need to be able to work together, it’s vital for a doctor to be able to recognize and show empathy for the patient/caregivers’ point of view.
Addressing a patient (or caregiver) concern is one step further than validation. Instead of being about the patient’s biases or perspectives, it’s about the physician’s concerns, beliefs, and recommendations about the situation.
This is explaining the “why” to both the patient and caregiver so they can feel empowered to self-manage their own health.
“You don’t always get it right. But If you at least listen [it goes a long way in your ability to help solve the problem and to communicate with patients.] So many times I have had patients come back to me and say, “You are the one who took the time to listen to me,’” says Dr. Bennett.
Patient-Centered Care: How Caregivers Can Help
For caregivers assisting loved ones on medical visits, it helps to bring up any questions or information you have early on during your visit.
“Bring a list of questions you have written down. Bring it up early, and that can help the doctor,” explains Dr. Bennett. He recognizes physicians should make it their objective to answer any lingering questions caregivers or patients have.
“We need to do a better job of asking the right questions, and being mindful of the patient’s agenda, but the patient—or the caregiver when applicable—can help themselves by preparing a list, doing some research, and then having that information front and center.”
Dr. Bennett is currently a Peds ID Attending at CT Children’s Medical Center in Hartford, Connecticut. He has a passion for teaching and practicing patient-centered care, along the way developing curriculum for Pediatric communication skills teaching for the medical students at SUNY Upstate. He went to medical school in Cambridge, England, then trained in pediatrics and pediatric infectious disease at SUNY Upstate. You can find Dr. Bennett at @Peds_ID_Doc and at his blog, Culture and Sensitivity.