What does “patient-centered” really mean? The term seems redundant; isn’t health care, by definition, something that centers on a patient? Yet healthcare delivery is currently built around billing and reimbursement, and medical forms, filled with jargon and acronyms, are meant for the providers, not patients, to understand. Transparency and communication are at the heart of much of the current effort to reform and improve the healthcare system. Realigning the focus will take a cultural shift and a concerted effort, both from the healthcare providers and administrators, and the patients themselves.
As a teenager, I worked in a pharmacy at a local drug store. In those long ago dark days, doctors still handwrote scripts on pieces of paper that the patients would hand over to have filled. The pharmacists were famous for their ability to read the almost always indecipherable scrawl penned by the doctors. I asked why doctors wrote so badly, and was told it was because they didn’t really want the patients to know what was being written—an answer I found puzzling. Wasn’t the patient expected to take the medicine, according to a prescribed regime? It seemed odd that the doctor and pharmacist expected to have insider communication that the patient was not privy to.
Jump forward to the present, and the patient is now expected to be in the driver’s seat, exerting authority over all steps of the health care process. It is big shift and important to see how this change is unfolding. National Coordinator for Health IT Farzad Mostashari, in his latest HealthIT Buzz blog post, predicted that consumer and patient use of health information technology would continue to escalate in 2012 and that it would enable them to become better informed about their health and more engaged with their own care than ever before. He predicted that by allowing consumers to see their own information will make them more empowered partners in their own care.
Physicians are now expected to learn “patient-centeredness” as one of their core medical skills so they can incorporate it into their daily practice. But many clinicians may be unfamiliar with what is involved in practicing medicine with the patient at the center of his or her care, despite it being a foundation for improved quality and new delivery models.
For example, consider a provider treating a patient who is classified as obese. It is commonly acknowledged that obesity is the root of many additional health problems; any interaction between the provider and patient should seize upon the opportunity to engage the patient in managing and improving this condition. This seems so obvious, in fact, that in December, the Centers for Medicare and Medicaid Services (CMS) approved a generous and comprehensive reimbursement program for primary care physicians to provide obesity counseling to Medicare recipients. Yet many have commented that physicians aren’t necessarily trained to engage in this fashion, and that bad counseling could be even more counterproductive than no counseling.
There are differing ideas as to what defines “patient-centered,” but a common understanding is that the patient has shared decision making in the health care process. Physicians and the healthcare system should be helping patients to acquire the literacy to understand risk and to advocate on behalf of themselves, so they can make good decisions to manage their care. Many feel patient-centeredness training should be a part of education in medical schools, training for residency, and included within competencies for certification and re-certification.
In addition to ensuring providers have the training to engage with patients, there is evidence that other cultural shifts will be necessary. Transparency in information has not been the traditional model. While patients themselves are quite interested in accessing the notes doctors write about them after an office visit, doctors worry about the impact of such transparency on their patients and on their own workflow, according to a study published in December. Such notes have traditionally “belonged” to the doctor, and many expressed concerns that allowing patients to see them might create unnecessary confusion or worry. Additionally, many predicted that notes would be less candid and complete if patients could view them. In contrast, the near 38,000 patients participating in the study were almost unanimous in their desire to have access to such information. Furthermore, a similar Veterans Administration study showed majority would willingly grant access to such information to a spouse or partner as well.
The goals of health care reform mandate a patient-centered approach; as the process moves forward, it is interesting to see how various stakeholders are reacting. Next blog: a look at some of the innovative and effective ways organizations are re-thinking engaging with patients.
Find Us Here