How Far Have We Really Come on Patient-Centered Care?

Across the country, there is a shift from paying for volume of health care to paying for quality and efficiency. Patient-centered care – defined by the Institute of Medicine as “care that is respectful of and responsive to individual patient preferences, needs, and values” – is one of the key ingredients of care quality. Patient-centered care also can help lower medical costs and reduce the need for some health care services, according to research by the University of California-Davis Health System.

So if patient-centered care results in higher quality care at a lower cost, it makes sense that this concept would be widely adopted. It turns out, if you look closely, we really haven’t come very far. The British psychoanalyst Enid Balint is credited with coining the term “patient-centered medicine” in 1969, yet on a 2012 patient-to-patient online forum, I find the following post: “I have the most basic question – how do I find a good specialist who also welcomes an engaged patient? I have a very competent doctor who scoffs at my efforts to self-educate and discounts my findings, yet doesn’t communicate even the basics, only dictates what I should do next.” Numerous people responded to this post to share their own experience with a provider that did not exhibit a “patient-centered” approach.

The topic is highlighted in a recent article in the March 1 issue of the New England Journal of Medicine, “Shared Decision Making – The Pinnacle of Patient-Centered Care.” The authors write: “Caring and compassion were once often the only ‘treatment’ available to clinicians. Over time, advances in medical science have provided new options that, although often improving outcomes, have inadvertently distanced physicians from their patients. The result is a health care environment in which patients and their families are often excluded from important discussions and left feeling in the dark about how their problems are being managed and how to navigate the overwhelming array of diagnostic and treatment options available to them.”

To address this “inadvertent distancing of physicians from their patients,” many are focused on the concept of patient engagement. Christine Bechtel of the National Partnership for Women and Families wrote in a forward to Transforming Patient Engagement: Health IT in the Patient Centered Medical Home: “The bottom line is this: You can’t be patient-centered without both patient engagement and patient involvement in the way care is provided.”

Transforming Patient Engagement, a 2010 publication of The Patient Centered Primary Care Collaborative, can be used as a resource for providers looking to focus on providing patient-centered care. It contains a dozen papers and two dozen case examples that touch on many facets of patient engagement. The papers include everything from one-on-one strategies for engagement, such as motivational interviewing and shared decision-making, to practice structural changes, including team-based care and intensive chronic disease management.

While it would be beneficial to have a gauge of how engaged a patient is, most providers report that they lack systematic collection or discrete reporting of a profile of their patients’ level of engagement in their own care. Recognizing this gap, Press Ganey and the American Medical Group Association recently announced the launch of a unique survey tool, the Coordinated Care Survey, which asks patients to assess their own behaviors and beliefs, not just their perspective on the providers’ performance.

Moving from traditional passivity to active, informed engagement will be an unexpected challenge for many patients. Those who are unable or unwilling to participate actively and knowledgeably in their care are more likely to suffer preventable illness, receive less effective care, pay more out-of-pocket costs, experience poor outcomes and suffer a diminished quality of life.

Moving from a patriarchal role to a partner role will be a challenge for many providers. Those who are unable or unwilling to actively practice “patient-centered care” may lose out on compensation or bonus payments that are based on quality care, lose out on favorable reimbursement terms or even lose their job.

The shift to patient-centered care may be full of challenges, but the stakes are too high for all of us to let another few decades pass before “patient-centered medicine” is the norm.

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