Patient-Centered Care – We Aren’t Ready for It

The follow is a guest post by Aanand D. Naik, MD  @empoweringpts.

We hear lots of discussion nowadays about Patient-Centered Care.  Most legislation for health care reform proposes innovative models of care such as Accountable Care Organizations and the Patient-Centered Medical Home (PCMH) with “Patient-Centered Care” at the core.  Given all the attention: Who could possibly be against Patient-Centered Care?

In this wake, I forward the controversial contention that many patients, probably a majority of health care providers, and every major health plan and health insurer really doesn’t believe in Patient-Centered Care.  Or at the very least, they aren’t ready to change the basic paradigms of health care to cultivate what Patient-Centered Care truly is and what its requires.  Simply put, we aren’t ready for Patient-Centered Care.

To clarify my argument, a clear understanding of Patient-Centered Care is needed.  The first consensus definition comes from the 2001 Institute of Medicine Report, Crossing the Quality Chasm.   The IOM report defines Patient-Centeredness as, “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”  The report clarifies several principles of health system redesign that will better align health care along 6 quality dimensions.  The principles most closely tied to the dimension of Patient-Centeredness include: a) customization of care based on patient needs and values; b) the patient as the source of control; c) shared knowledge and the free flow of information, and d) the need for transparency.

When fully realized, these are powerful principles–they can and will transform health care.  But, they must all occur together to ensure that transformation happens.  If only one or two of these principles are accomplished, especially if only the principles of free flow of knowledge and customization based on patient-need; then there will be little positive change at all.

Don Berwick wrote a wonderful essay in Health Affairs in 2009  in which he describes the lively debate that occurred on the IOM panel that defined Patient-Centered Care.  He defends the “extremist” position and adds his own parameters for patient centeredness: (1) “The needs of the patient come first.”(2) “Nothing about me without me.”(3) “Every patient is the only patient.”   These are compelling additions to the original IOM definition.  What I fear is that without the coexisting principles of transparency and patient control, the “needs of the patients” will be defined by doctors, providers, hospitals, health systems, and insurers rather than patients themselves.

My further belief is that the types of reforms gaining momentum, like PCMH, will actually precipitate and worsen the problems of supply-driven demand and hyperinflation because they will simply increase patients’ acceptance of doctors’ recommendations through “free flow of information and knowledge” and enhanced patient-centered communication.

Without truly making information transparent and giving patients real control of the ends and means of health care, then it’s simply patient-friendly talk and involvement in discussions related to what the doctor thinks is best.

Transparency is more than the free flow of information and patient-centered communication.  Transparency occurs when patients understand “in their gut” the meaning of the health problem and how health care will impact their daily lives.  Patients have control when they choose not to pursue a course of action the doctor might recommend because those outcomes are not consistent with their values or the desired course of their lives.  In the non-transparent form of PCMH, access to health care improves but health costs will continue to skyrocket.

What we need now is real discussion of patient control and transparency rather than platitudes about Patient-Centered Care.  What does it mean to give patients control and can control be helpful and lead to health outcomes that are consistent with our needs and values?  What does transparency really mean?  I wish Steve Jobs was still around to teach us a thing or two about the importance of design and the patient-interface in health care.  As a physician, I know the patient-doctor encounter is sacred and the doctor’s role is indispensible; but I am also fully ready to embrace transparency and patient-control over the ends and means of their health.

Aanand D. Naik is a medical geriatrician and health services researcher at the Michael E. Debakey VA Medical Center and Baylor College of Medicine in Houston, Texas.  Follow him on twitter @empoweringpts  The views expressed here have not been endorsed by either institution.

Sources:

Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001, National Academy Press, Washington, D.C.

Berwick, Donald. What “Patient-Centered” Should Mean: Confessions of an Extremist. Health Affairs. 2009, 28:w555-w565.

Patient Engagement Infographic

Check out other recent posts on the topic of Patient Engagement:

Patient Engagement Is Very Important – It’s Just That No One Agrees On What It Is…Or How To Do It – Infographic

Patient Engagement From The Patient’s Perspective

Patient Engagement Versus Physician Engagement – Which Comes First?

Patient Engagement – Here’s The Key To Success

Patient-Centered Communications – A Great Differentiation Strategy For Primary Care Physicians

More and more it seems that primary care physicians are becoming commoditized.   You know…where there is nothing to differentiate one group of physicians from another group of physicians down the street.

I really don’t understand why primary care physicians don’t make more of an effort to “stand out” from the competition in some meaningful way.   Being a former hospital marketer, I am even more surprised that hospitals systems, which now employ many primary care physicians, have been so slow to recognize the benefits of differentiating their physician partners from those across town.

That’s why I was surprised with a TV ad which I saw in my local San Jose market run by John Muir Medical Center in Walnut Creek California.   The ad is the first I have seen which uses their physicians’ patient communication skills to differentiate themselves from competitors.    Given that poor communication is the number one complaint most people have about their physician,  this is a great strategy.

In truth I can’t say that John Muir’s physicians are any better at communicating with patients than any other groups of physicians.  I would need to see evidence beyond that captured in patient satisfaction surveys.   You know…the same satisfaction survey everyone uses with the same wonderful results.   What I can say is that if in fact the ad is factually correct, John Muir is on to something.

With Patient Expectations Of Their Doctor’s Communication Skills Being So Low – It Easy For Physicians With Good Communication Skills To Stand Out

Poor communications is an issue for  my doctor and I.   I am reluctant however to change doctors because I doubt that other physicians are any better when it comes to patient communication.   But what if they were!

What if the physicians affiliated with a particular hospital system actually did communicate measurably better than their competitors?  With the advent of the Patient-Centered Medical Home, there’s lots of talk about primary care physicians becoming more patient-centered.    Why don’t hospital executives begin helping their physicians, both independent and employed, become more patient-centered in the way they communicate with patients through training programs?   After all patient-centered communication is the gold standard  for how provider should communicate with patients.  Even more interesting would be those same hospitals teaching patients how to effectively engage their physicians in discussing ways they can get more involved in their own care.

Just imaging patients walking out of your physicians’ offices amazed and delighted that their physician:

• asked their opinion
• invited their questions
• was present in the moment and
• actually listened to what the patient had to say.

Effective patient centered communication is one great way for primary care physicians and their hospitals partners can to avoid being commoditized and to stand out as market leaders.   Are you ready?

That’s my opinion, what’s yours?