Why hospitals and physicians should get serious about patient-centered care

Health care professionals are a cynical lot.   We joke about the “fad or buzzword of the month,” usually some vague concept heralded by the powers on high.   Our job is to promote the idea, knowing full well that the “next big thing” is probably right around the corner.

Take “patient-centered.” It sure feels like a buzz word.   I suspect most hospital and physician executives, and their ad agency partners, would agree.  But this time things are very different.

Here are reasons why hospitals and physicians should get serious about patient-centered care.

1. Patients are starting to discover that their doctors and hospitals are not nearly as good as they should be.

“Pay no attention to that man behind the curtain.” This line comes from the Wizard of Oz where little Toto rips the curtain back to show the great and powerful Oz is merely an old medicine show marketer from Kansas.

The analogy is a good one.  Patients across the U.S., and other countries, are “doing a Toto” as they pull back the curtains on doctors and hospitals only to learn that they are often not getting the quality of care they expected.

People every day hear about some story that undermines their confidence in the health care system.  Doctor Smith at XYZ hospital amputated the wrong limb again, Sally down the street was given the wrong medication, Mr. Patel’s opinion was ignored by his doctor, and so on.  Unlike years past when such stories were infrequent and seemed to occur in some other city… stories now appear daily, occur in my city, and are instantly shared with people around the world via the internet.

2. Patient-centered care is the right thing to do, and it’s not that hard

I think most would agree that today’s health care system is still very provider-driven.  That means that the care that is delivered, how it is delivered, who delivers it, and how outcomes are measured are all defined from the providers’ perspective (physicians, hospitals and payers ).   Patient-centered care simply means looking at these same issues but from the perspective of individual patients.   Notice nowhere here did I equate patient-centered care with smile training, customer service training or pianos in attractive lobbies.  Patient-centered care means involving patients in the planning, delivery and evaluation of health care where it really counts in terms of outcomes, patient adherence, cost reduction and fewer re-hospitalizations.

Being patient-centered is like doing a market research study and then implementing the findings.  Patient-centered care does not give absolute control to patients, it simply invites them into the party and gives them a place at the table.  As providers, we don’t do a good job of listening to patients.  We do an even worse job when it comes to acting on what patients tell us they want.

3. Patient-centered care will make any hospital or doctor stand out from the crowd.

Like a beautiful rainbow, patients and providers will recognize patient-centered care when they see it.   Like rainbows, example of patient-centered care are few and far between, but here are some tell-tale signs:

  • Providers and patients know each others’ names
  • Patients’ opinions are actively sought, listened to and honored where possible (no, a suggestion box, patient satisfaction survey or mission statement constitute being patient-centered — if you think they are then you aren’t patient-centered)
  • Patients tell you that their doctors and other team members really listened to what they had to say (again if you think satisfaction surveys qualify you aren’t there yet)
  • Patients are treated as the most important member of their health care team and taught how they can best contribute to the team’s success
  • Providers feel that their patients are actively involved in their own care
  • You see a significant improvement in patient health status, adherence, engagement, level of utilization and patient/provider experience

If these aren’t good enough reasons to give patient-centered care another look at your organization then just think about this.  Beginning in 2013, 30% of hospital Medicare reimbursement will be determined based upon patient experience.  Eventually commercial payers will follow suit.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • http://www.facebook.com/knasky Kevin Nasky

    I do think this is a buzzword and a fad.  Physicians are dedicated, solely, to the health and well-being of their patients.  To say that we need to switch to “patient centered” is insulting as it suggests that we’ve been “centered” on something other than that.  If anything, patient-centered-ness will result in poorer outcomes.  When doctor and patient priorities don’t match, it’s often because the patient’s priorities are at odds with good medicine (i.e. abx for viral URIs, the narcotic-seeking ER pt, etc.)  I’m a psychiatrist, and couldn’t imagine what a switch to “patient-centered” would look like.  What’s missing from medicine is NOT more time spent eliciting patient opinions about their care.  A patient is no more a partner in their care than I am a “partner” of my auto mechanic when he adjusts my timing belt. I don’t “partner” with my barber, or my accountant, or the plumber. These are all professions I know nothing about, and hence I defer to their wisdom, training and judgment when I seek our their services. Patients should do the same when they seek our services.  Heck, when I go to a doctor, I don’t consider myself a “partner”…I’m a PATIENT!

    • Anonymous

      Amen Kevin! You beat me to the punch. I’m am very tired of “executives,” “clipboard-nazis,” PhD’s, and others who have no
      medical training or real-world experience trying to tell me my business! This is ridiculous and a reflection of our increasingly entitled and whiney society. Mr. Wilkins, maybe we should let patients read Cecil’s textbook of medicine and tell us what treatments or tests they would like. Would that achieve your directive? I guess then they would only have themselves to blame for a poor outcome. And. If you think doctors are going to be held hostage by Medicare patient satisfaction scores, you got another thing comin’

      • Anonymous

        As a customer service trainer in the healthcare field, I find the abrasive responses posted here more than a little disturbing.  Every other business in the world is realizing that communication and relationship are core to success.  Denial of this fact is like putting your head in the sand.  Creating an environment of open dialog and relationship building should not threaten the expertise of any physician but will foster better care as the patient conveys more important information re symptoms etc to the physician.  The wonderful side benefit is that a patient who does have this kind of relationship is about ten times more likely to refer the physician to friends, family and co-workers thus bringing dollars to the bottom line.

    • Anonymous

      The biggest scam in the “patient-centered” industry is the “Patient Centered Medical Home.” If you read the guidelines, you quickly realize that it’s actually the Administrator Centered Medical Data Collection Center.

      That the AAFP brass thinks this will save primary care is pathetic beyond belief.

    • http://www.facebook.com/brianpcurry Brian Curry

      But you do partner with your mechanic (you take it in, he/she diagnoses the problem, and then comes to you to discuss what you’d like done – maybe the repair is quick and effective, for a relatively low price, but maybe a given repair is unbelievably expensive, and would only increase your car’s life by, say, a month or two, tops), your barber (or do you just tell him/her, “Just do whatever you think is best”), and your plumber. The idea being put forward here is that care plans should not be conceived, implemented, and evaluated without patient input, or without some idea of what the patient values.

    • Steve Wilkins

      Kevin et al,

      I am sure that when you take your car into the dealer’s mechanic for
      service you have an idea of what needs to be looked at…perhaps there
      is a persistent engine light or a unfamiliar sound. Maybe the
      manufacturer issues a recall on you model of vehicle. No doubt you feel
      free to share your thoughts and concerns with your professional
      mechanic, after all its your car and you need it to get around.  If you
      subsequently picked up your car having been told it was fixed…from the
      mechanic’s perspective…only to find that the noise was still there as
      was the engine light…you would probably not be happy and you would
      say something to the service manager.  The service manager will listen
      to your concerns and address them.  I sincerely doubt the service
      manager would not question your knowledge or ability to have an idea or
      expectation as to what your car needed.

      Now let’s apply your mechanic analogy to the typical patient
      experience.  People go to their doctor for a reason – usually multiple
      reasons actually.  We, speaking here as a patient, have concerns, health
      beliefs, previous health experiences that shape our expectations of the
      doctor visit.  In the traditional physician-directed model of
      doctor-patient communication, the physician often “sizes up the patient”
      based upon their first complaint, interrupts the rest of the patient’s
      opening statement and proceeds on the basis of their preliminary
      diagnosis.

      In the patient-centered model, the physician would take the extra 6
      seconds to fully elicit the patients’ agenda, prioritize what time will
      enable them to discuss, agree as to what will be discussed and go from
      there.  Patient-centered simply means that you actively consider the
      patient’s perspective (by asking) before you do anything to them.  So
      for example if the patient wants you to make all their health decisions,
      the patient-centered physician would honor their perspective and not
      force them to do something they don’t want to do. That’s all
      patient-centered care means soliciting your patient’s thought and
      opinions.

      The evidence clearly favors the patient-centered approach.  Physicians
      that employ a patient-centered communication style with patients have
      better clinic outcomes, patients are more engaged and adherent, they use
      fewer diagnostic tests, they are more effective in self care
      management, they and their doctors are more satisfied,and are much less
      likely to be sued.  That makes adds up to pretty compelling case for
      many physicians. I’d be happy to share the research citations with you
      if you are really interested.

      The tell tale sign of a physician-directed communication style is where
      the doctor spends their time trying to convince the patient to do what
      the doctor believes is in their best interest. That’s kind of

      like the mechanic telling you you need a major engine re-build when you
      don’t agree and fear the mechanic is just trying to sell you work you
      don’t need.  That approach doesn’t working so well. 

      I would really appreciate one of you fine physicians explaining to me, a
      mere patient, what is so wrong or scary about listening to your
      patients.  To quotes William Osler, Listen to your patients, they will
      tell you what’s wrong.

      Steve Wilkins, MPH and patient (3 days post retinal detachment Vitrectomy)
      http://www.healthecommunications.wordpr ess.com

    • http://www.facebook.com/people/Craig-Koniver/100001463176810 Craig Koniver

      I am a Family Medicine doc and I disagree with you when you say that most doctors are centered on something other than patients. I believe most doctors are focused on the medicines, not the patients. I know your argument is that patients who are sick need the medicine to get better and therefore while we should take their opinions into account, it is up to us, the professionals to determine what is best. The reality is that as physicians, we spend most of our time managing the medicine and not the patient. Sure, medicines can be extremely helpful, but what truly matters for a patient to do better is to have a strong connection and relationship with their physician. We have more people taking more medicine than ever before in the history of being human and yet we have much more disease. Why is that?

      Most doctors feel that patients are not compliant and therefore it is the patient’s fault. The way I see it, unless you truly connect with your patient as this article outlines, why in the world would your patient want to follow your plan? Just because you have an MD? There are tons of doctors out there and tons of advice all over the place. Doctors have overvalued their role for far too long here. Much better for doctors to work more on communicating than on studying the next protocol or guideline.

    • http://pulse.yahoo.com/_KKI4SK2ANH7QBIDGTL66MIOOX4 deb

      Sir I have been in the medical field for 36 yrs and from both a pt prospective and care provider stance -if the patient is not a partner in care then the doctor is missing the boat. The pt should be proative and fire him or her. How many times does a pt go into the office and get barely more than a handshake. I always figured and was taught by some GREAT doctors the PATIENT knows how they feel and family members see CHANGES. I have worked for primary and specialty care and believe me I would much rather have my old fashioned doc who knows what a liver flip is than one who simply sends you for an MRI. I recently went to the ER with a Stroke and was sent home because the ER doc thought I was an addict because I had taken 2 Vicoden in the past week for spinal deterioration with severe bone spurs. I was completely flaccid on left side, slurred speech loss of vision, incontinence but my drug screen came back positive for vicoden which he was told about and klonopin for seizures.Also the same facility told me the pain in my knee was my imagination when in actuality 6yrs ago i needed a complete replacement and am now pain free in that leg. So there are a lot of things to consider- both pt and docs need to collaborate and it would not hurt to listen to your nurses.

  • http://twitter.com/livewellthy Stewart Segal

    I think the point of this new initiative is simply for Medicare to justify paying 30% less!  Hospitals will never make patients happy/satisfied.  Sick people get admitted to hospitals, some get well, some get worst, all have to put up with IV monitors going off, roomates puking, institutional food, etc.

    • http://twitter.com/waheedb Waheed Baqai

      To clarify this well meaning post by Mr. Wilkins, 30% of 1% of total inpatient Medicare reimbursement to hospitals (not physicians) will be based on patient experience (HCAHPS) beginning in 2013.  The performance period for such payments started in July 2011 and goes through March 2012.

  • anas wajid

    Well, I can’t agree more. We certainly need more patient centric care.

  • Steve Wilkins

    Kevin et al,

    I am sure that when you take your car into the dealer’s mechanic for service you have an idea of what needs to be looked at…perhaps there is a persistent engine light or a unfamiliar sound. Maybe the manufacturer issues a recall on you model of vehicle. No doubt you feel free to share your thoughts and concerns with your professional mechanic, after all its your car and you need it to get around.  If you subsequently picked up your car having been told it was fixed…from the mechanic’s perspective…only to find that the noise was still there as  was the engine light…you would probably not be happy and you would say something to the service manager.  The service manager will listen to your concerns and address them.  I sincerely doubt the service  manager would question your knowledge or ability to have an opinion as to what your car needed.

    Now let’s apply your mechanic analogy to the typical patient experience.  People go to their doctor for a reason – usually multiple reasons actually.  We, speaking here as a patient, have concerns, health  beliefs, previous health experiences that shape our expectations of the doctor visit.  In the traditional physician-directed model of doctor-patient communication, the physician often “sizes up the patient”  based upon their first complaint, interrupts the rest of the patient’s opening statement and proceeds on the basis of their preliminary diagnosis.

    In the patient-centered model, the physician would take the extra 6 seconds to fully elicit the patients’ agenda, prioritize what time will enable them to discuss, agree as to what will be discussed and go from there.  Patient-centered simply means that you actively consider the patient’s perspective (by asking) before you do anything to them.  So for example if the patient wants you to make all their health decisions,  the patient-centered physician would honor their perspective and not force them to do something they don’t want to do. That’s all patient-centered care means soliciting and where possible honoring your patient’s thought and opinions.

    The evidence clearly favors the patient-centered approach.  Physicians that employ a patient-centered communication style with patients have better clinic outcomes, patients are more engaged and adherent, they use  fewer diagnostic tests, they are more effective in self care management, they and their doctors are more satisfied,and are much less likely to be sued.  That adds up to a pretty compelling case for a patient-entered approach many physicians. I’d be happy to share the research citations with you if you are really interested.

    The tell tale sign of a physician-directed communication style is where the doctor spends their time trying to convince the patient to do what the doctor believes is in their best interest. That’s kind of like the mechanic telling you you need a major engine re-build when you don’t agree and fear the mechanic is just trying to sell you work you don’t need.  That approach doesn’t work with your spouse and I doubt it work much better for your patients.  

    I would really appreciate one of you fine physicians explaining to me, a mere patient, what is so wrong or scary about listening to your patients.  To quotes William Osler, Listen to your patients, they will
    tell you what’s wrong.

    Steve Wilkins, MPH and patient (3 days post retinal detachment Vitrectomy)
    http://www.healthecommunications.wordpress.com

    P.S. If any physicians would like inormation on how to assess and benchmakrk just how patient-centered their communication style is please e-mail me at swilkins@gmaildotcom..

    • http://www.facebook.com/knasky Kevin Nasky

      Extra six seconds, eh?

  • Bradley Evans

    What evidence?

  • Bradley Evans

    Does anyone else watch Doc Martin? I liked seasons 1-4. I am not sure I like season 5. It looks like the guy is going to have a meltdown.

    I mention this because, when I ask for evidence, the response is usually, “All you have to do is look at Europe or England! What are you, stupid?” Doc Martin is based in the UK. In fact, House is played by an English actor. The point is, the English are pretty familiar with doctors who have poor social skills.

  • Steve Wilkins

    The evidence supporting patient-centered communications:

    Here’s  a few studies addressing impact of physician communication style on outcomes…there are many more.  Hope this helps …. 

    Krupat, E., et al. (2007). Communication Practices of
    Physicians With High Patient-Satisfaction Ratings. Permenante Journal, 11(1),
    19-29.

    Levinson, W. et al. Developing physician communication skills for patient-centered care. Health Affairs. July 2010. 29:7.

    Roter, D. et al. The Communication Patterns of Internal Medicine and Family Practice Physicians. JABFP November–December 2003 Vol. 16 No. 6.

    Heisler, M., et al.  (2003).
    When do patients and their physicians agree on diabetes treatment goals and
    strategies, and what difference does it make? Journal of General Internal
    Medicine, 18(11), 893-902.

  • Bradley Evans

    Let’s say I take my car to a mechanic. I don’t like the opinion I get, I don’t like the recommendations. What are my options? I can stick with the guy, figuring he knows better than I do. I could take my car somewhere else. I could complain. Look at the take my car somewhere else option. Suppose I say, “I can’t take my car somewhere else because blah, blah, blah” You could as a strategy look at blah blah blah and reduce the barriers. This is not the strategy Wilkins recommends. He wants you to complain. Who do you complain to? The boss, then to the boss’s boss, etc. He creates a bureaucracy.

    I am sure there are good things about bureaucracies. Their mothers probably love them. One characteristic is that they are good for centralizing control. Why is this a concern? Because, unlike the car repair analogy above, someone else is usually paying the health care bills. They want central control because they can control what the doctor orders. Everyone wants to control doctors: Insurance companies, governments, pharmaceutical companies, hospitals. These entities often do not have the patient’s interest in mind.  

    So, it’s hard for me to see that putting up a bureaucracy will result in better patient care. I’d like to see the data.

    • Steve Wilkins

      Bradley,

      If I had a complaint I would discuss it with my doctor. If I wanted to change doctors I would change doctors. Bureaucracy??  What on earth are you talking about?  That’s your interpretation not mine.  All I know is that physicians that communicate and relate well to their patients have nothing to worry about.  As for the physicians that are unwilling or unable to do so…there’s always Obama’s job plan that you can turn to for employment. 

      Good luck with those patient relation skills.

      • Anonymous

        I think we’re talking about two different things here.

        Mr. Wilkins is talking about improved communication skills, which no good doctor is against.

        However, as demonstrated by the posts here, docs now see red when they hear the term “patient-centered.” They quite correctly realize that 99.95% of the time it is a euphemism for meaningless administrative busy work that only interferes with good patient care.

  • http://twitter.com/#!/CloseCall_MD Close Call

    Of course we should have patient centered care!  

    Of course we should take the extra time to elicit the patients’ motives, fears, dreams, biosocial construct of their disease, their stressors in life, their views on the pharmaceutical industry, alternative medicines, what their mother-in-law said told them about vitamins over dinner last night.  That’s what current family medicine residents are trained to do.   Now, do they have the TIME to do that?  Will the proponents of patient centered care actually PAY them more to take that extra time.  No way.  

    I call BS on this.  Buzzwords created to find out ways to pay doctors less.

  • amy sarah marshall

    I love how you have highlighted this issue with concrete details on what it looks like to have patient-centered care. I’ve shared with our department.

  • Anonymous

    Hospital executives have no standing to advise us on how to practice.  They are moneymakers, pure and simple.  
    Pt-centered care is gobbledygook, MBA-speak.  It has no merit.

    • Steve Wilkins

      Buzzkillersmith…try reading before responding with your knee tendency to dismiss anyone that doesn’t agree with you.  That’s kinds like a doc who walks into the exam room…interrupts the patient during their opening comments and procedes to make a diagnosis based upon incomplete information.  Too many preconceived prejudices for someone who is supposed to be an object, open minded clinician. 

      Yes I have a health care professional background but…I as I said I am also a patient and a care giver.  I have as much standing in any discussion of the health care system as you do…probably more.  Plus I am not afraid to use my real name.  Google me and you will see I am prepared to back up my comments with facts and real experiences.  

      Given how you treat people here you disagree with I can only imagine how you treat patients that don’t tow your line of thinking. 

  • heartsurgeryguide.net/

    disagreement with being patient centered is like debunking home cooking, motherhood , apple pie and harvard medical school. unfortunately, there is a lot of mba promo-speak in describing how to implement and the promise of better results. but let us quantify what those better outcomes are, not the joy of more patient visits and profit margins.  how in fact did the new processes work.  the current medicoeconomic environment has every one scrambling for a schtick, and patients like warm and fuzzy. quite frankly, the american public is not focused and ignorant of evidence -driven therapeutic choice. if we can meld patient centric with best choices of treatment we have a winner.  beware the slippery slope where patient-centered is a surrogate for pandering to public whim, it is not that far away. think how many times patients come to the office armed with google-searched printouts of the next, next best thing and demanding that treatment (whether their insurance network provides it or not).  noninvasive, less pain, robotic– all te buzz words. yes, this is going astray, but somewhere, somehow the medical professional must know what is best, informed consent does not immediately confer comparable knowledge. i see patient centering as improving compliance, then you can call it education and lose the infuriating, marketing fluff.  practitioners can not be troglidytes, better to join the hypers because we will never eradicate them.  we can at least focus the direction on quantifiable outcome not just better process, one does not always lead to the other.

    • Steve Wilkins

      Heartsurgeon,

      I agree that it’s way too easy for “marketers” to call their facilities or physician staff “patient-centered” if they can’t back it up with evidence.  I am disturbed by the fact that many accredited Patient-Centered Medical Homes are less patient-centered than many physician practicing in non-accredited practices.  Bottom Line I agree with your concern about term being co-opted by marketers for the wrong reasons. 

      The concept behind patient-centered care is not new…nor is it hard to understand. Every patient comes to their provider with different needs, concerns and expectations. As defined for the last 30 years, patient-centered care
      (in contrast to physician-centered or provider-centered care) simply means that it is beneficial to the provider and patient if the provider takes the patient’s perspective into account when diagnosing and treating them.

      Patient-centered care is also often referred to as collaborative care, family based care and relationship based care.  The practice of motivational interviewing includes the very same skills and practices associated with patient-centered care. So I don’t get too hung up on what you call it…as long as the intent is there. Hope this helps advance the discussion…

      • heartsurgeryguide.net/

        Amen

  • Guest

    Full disclosure: I’m an occupational therapist, not a doctor. But I want to add my
    two cents here because the “patient-centered” credo dominates my
    profession as well, and I share many of the concerns voiced by commenters. 

    Striving for patient-centered treatment is both the best and worst part of my job—it is
    also almost unavoidable. I work at a skilled nursing facility, where I’m
    required to see individuals for about 45 minutes a day, 5 days a week, for
    often 2 or 3 months. During our time together, I need to get patients to do things–to participate in their own
    recovery through exercise or taking care of themselves (dressing, toileting,
    learning to use their assistive device). I can’t force a patient to go to the
    gym or to wipe his own bottom, so I have to make these tasks relevant and
    desired by him, which inevitably means that if they’re done at all, they’re
    done on the patient’s terms. 

    I approach each patient with a plan of exercise and activity that
    “should” lead most efficiently to recuperation, but honestly, nothing
    gives me more satisfaction than customizing treatment on a patient’s request,
    because just by asserting her concerns, goals, and preferences, the patient has
    demonstrated herself more self-aware, thoughtful, engaged, and reality-grounded
    than most. Patients who have some specific goal and some modicum of initiative
    seem to make the best recovery.

    However, patient centeredness can also be mind-bogglingly, soul-crushingly frustrating, as
    when my treatment plan dies the death of 1000 cuts with the patient
    negotiating every point. Amazingly, recuperation seems not to be the priority of some patients. It used to surprise me that some people would refuse to
    follow precautions, refuse to change their lifestyle, and yet staunchly blame
    everyone except themselves for their own decline. The shock has worn off,
    although the disappointment lingers.

    Proponents of “patient-centered” care typically describe an ideal patient, one
    who is both educated and rational. Experience has introduced me to a large
    proportion of people who are neither. Acting alone, they are quite unprepared
    to make decisions and take actions to favor their health. Even given direction
    from someone who really is educated and rational (the ideal doctor or therapist—and
    let’s be honest: it’s an ideal), they refuse to follow that direction.
    Evidently being uneducated and irrational entails the inability to appreciate
    the qualities they so conspicuously lack themselves. You can lead a horse to
    water…  

    In those unsatisfying situations where the patient is practically refusing my services,
    I would love to be able to follow the course of patient-centeredness to its
    obvious conclusion by promptly discharging him from therapy. This would
    be the ultimate demonstration of respect for the patient’s wishes.
    Unfortunately, this is where the system exerts immense pressure to put profit
    over patient preference. Skilled nursing facilities hate to lose a therapy patient
    and the revenue that person represents, so OTs and PTs feel obliged to keep on
    folks whose gains hardly justify the amount of Medicare $ lavished on them.
    Perhaps you doctors encounter analogous situations.

    Don’t get me wrong: irresponsible, irrational, unmotivated patients really get me down.
    However, I see my profession as serving individuals—of all shades of
    rationality and capability. At the end of the day, it’s not so much patients’
    dubious decision-making that bothers me as the system’s own double-talk and sloppy
    incentivizing.

  • Kannan Hariharan

    Good article..could you please throw some light on different ways by which an healthcare organization can become patient centric. You’ve said in your article that the patient satisfaction surveys, suggestion boxes etc do not play an important role at all..so what according to you should be the practices followed to gauge patient needs.

    • Steve Wilkins

      Kanran,

      I say that suggestion boxes and surveys do not equate to being patient-centered simply because some organizations just want to take the easy way out by not making any meaningful changes, i.e., yes we have a suggestion and satisfaction survey so that means we are patient centered.  If incorporated into a larger program of reform they can be useful tools.

      Obviously the first step for any organization is to agree what patient centered means and why it’s relevant to them.  Then you have to identify meaningful standards and ways of measuring the various dimensions of patient-centered care and communication.  Finally you have to train you staff (including front line providers) to the standards.  You also need to teach patients what it means for them to assume more responsibility for their health and how to do it. It is not obvious to most patients.   

      I wrote a paper on the subject recently entitled “Improving the Patient Experience in Primary Care – Understanding the Patient’s Perspective.”  Send me your e-mail (at stwilkins@gmaildotcom) and I will e-mail you a copy.  If anyone else wants a copy do the same.

      Steve Wilkins

  • http://twitter.com/popm3d Emily H. Park

    All of these suggestions are very nice but I think pretty idealistic when insurance policies are forcing physicians to see an average of 20-25 patients a day in order to make a decent living. So maybe people should write articles about what insurance companies should be doing to help change the healthcare industry instead what doctors should be doing. 

    • Steve Wilkins

      Emily,

      Nice sentiment…but more time during the medical interview (presumably the point of your comment) probably would not improve the way most doctors talk with patients. Why? Because doctors like the rest of us develop approaches and habits they grow to rely on over time and that includes their communication style.  Providers with 5 more minutes will just use that time to do more of what they already do – tell patients what to do irrespective of what the patient thinks. This problem has been around long before managed care and doctors having to see 25 patients a day.

      On the other side of “time coin” is research which shows that patient-centered care takes about 6 seconds longer than traditional physician-directed care but with far superior results.  Now that’s what insurance companies should be looking at. Wouldn’t you agree?

      • http://www.facebook.com/people/Mary-M-Cable/100000033819014 Mary M Cable

        With advent of drg’s  hospitals focused on the bottom line ,money they no longer got.This is still the focus,Insuransce companies fight reembursment.If a pt gets a nosecomial infection the hospital eats the hole bill.Hospital employees are pts too.Staff layoffs ,flexing and cancellations are a fact of life.We have to do more with less staff and be glad we still have a job! And the health benafits for us SUCK!!!!! PT CENTERED CARE IS A JOKE ON THE PT.They don’t know what they need and are not fullky informed or donot care.

  • Zelda Zebra

    Perhaps I am from a different reality.  I have expected and when I can, insisted on patient centered care in my own health care for 20 years. I pay the bill!  The MD works for me! not the other way around.  It has been my experiences that it is not the physicians who resist this, but many hospitals do fight it tooth and claw.  And insurance seems to consider my opinions heretical.

  • http://www.facebook.com/people/Christine-Corbett/100001131194990 Christine Corbett

    One of the reasons I am so blessed to work at Hospice of CNY, where patient and family-centered care is what we do :)

  • http://www.facebook.com/people/Christine-Corbett/100001131194990 Christine Corbett

    One of the reasons I am so blessed to work at Hospice of CNY, where patient and family-centered care is what we specialize in :)

  • SharkBaitNZ

    Great article. Couldn’t agree with you more. However, patient-centered may still be too narrow. Rather call it person-centered, which would include people that are still healthy with the potential of becoming ill.

    Imagine the following scenario: Organisations could have systems that monitor various aspects of staff – sick leave, mood, accidents and incidents, productivity, combined with doing onsite primary health care and occupational health care, maybe even EAP. All this info has the potential to change the way we currently do healthcare. The system could forward any warning bells to the staff-member’s physician, who could in turn contact the patient to give advice on how to prevent a reactive incident, e.g. a heart attack as a result of high stress. Let’s face it, the employers spend more time with staff than anyone else. They are in a good position to proactively prevent many illnesses.

    All we need is a change of focus. Hospitals, doctors and other healthcare professionals get to see people when they are already ill. Why can’t we change that and prevent the illness where possible?

    I have been researching this topic for the last 8 years. Feel free to contact me at dieter.stalmann at equeue.co.nz if you would like more info.

  • Anonymous

    It will take a lot longer for a lot of these doctors to be patient centred care.
    A lot of them dont want the patient to know anything about what they feel.
    Oh sorry we have done a few tests and found nothing,Oh it has to be stress related.
    Sorry for ranting but these top doctors are not going to change.

  • http://pulse.yahoo.com/_TT7TBBLRAVAOEWDJ24LTS7EJ5Y JOHN

    as some dr.s have commented, it’s kind of insulting to assume their care is not  patient centered. it’s true that a fad hit most hospitals when consultants used the patient-centered buzzword as an excuse to charge hospitals  large sums for their “expertise”. it was just a phrase, and didn’t change practices. we still wake the  patients in icu at 11pm to bath them, then wake them at 5 a.m for blood tests, all for the convenience of dr.s and nurses. this  interference with sleep increases infections and cardiac death but few are ready to change at this point.patients will know that they are the center when these practices stop. 

  • http://pulse.yahoo.com/_E6S76U3KG4P34YRNI4SPNKJFWE Nalubwama

    It wil take sometime for medical personnel to treat a whole person as they know it is all about drug management not patient management this means being patient centred care they should who is a patient in different dimensions.

  • Anonymous

    Disclaimer: I’m a counseling psychologist where person-centered care is the basis of our training. With new models of health care, person-centered care, at least as the patient defines it, is being reduced. We are now required to monitor alcohol use, smoking, diet, and make referrals to physicians and other resources for medications and health-promoting programs, and to assess all medications (not just psychotropic meds) at every visit. Then there is the wellness assessment, the PHQ-9, the GAD, all in the service of tracking progress on goals that must be approved by an external reviewer, not necessarily what reflects a legitimate request by the patient.  Each session consists of these activities, releases of information to share their medical information with everyone in any medical center they may encounter, now or in the future. These requirements leave precious little time to address the reason why the patient sought services because someone with a spreadsheet defined patient-centered care without considering the goals of the patient. I’m all for evidence informed practice, but when the patient is lost in the mix, there is no benefit, only a costly outlay of resources and frustration.
     

  • Anonymous

    As a nurse in a critical care setting patient outcomes are mostly not good so how can this option work…Our manager considers patients “productivity” not someones mother, father, daughter or son…move em in move em out, ready to leave ICU or not..more often than enough they end up back wtih us in worse shape.  Staffing in Forida hospitals is horrendous..we Will be expected to take on three critical patients, on Vents or not..”again with the productivity” aspect…heaven forbid someone in management should not get their expected christmas bonus..I get a $25 wallmart card for working myself to death.  The multiple drug users we deal with who aren’t getting their “fix” are certainly not going to be satisfied with their care when the drugs they want are not prescribed…but thats a whole different can of worms….

  • Anonymous

    I don’t have a problem with the phrase ‘patient centered care’. I do have a problem with the idiotic mentality I see constantly promoted by hospital administrators wanting to treat patients like customers. Administrators have business degrees so the customer is always right mentality makes sense in the business world but it is quite simply BAD MEDICINE!

    • Steve Wilkins

      Benmarblemd

      Patient-centered care is juxtaposed with paternalistic or physician-directed care. It basically refers to way providers relate to and communicate with patients. As a style of communication, it simply refers to a communications style in which the provider takes the “patient’s perspective” into account when diagnosing and treating the patient.  It does not mean that the patient is always right…just that you make an attempt to find out what’s wrong with them from their perspective.  The article spells that out pretty simply if read.

      Not sure why docs don’t like to talk/listen to their patients?? Now that’s BAD MEDICINE .  I am speaking here as a patient…this is not a hard concept to grasp.

      Steve Wilkins

        

  • http://www.facebook.com/profile.php?id=1375942759 Tammy Gentry Schack

    It behooves each of us to be our own health “care” expert.  We tend to consider more options in vehicle maintenance than we do with our own bodies.  Why go to one doc and trust everything he/she tells you without seeing if it is the best treatment available?  We hire the doctors, not the other way around and it is perfectly fine to fire them if the relationship or plan of action and results are not completely satisfactory.

  • Isabelle Blankmeyer

    Just wondering…is this referring to value based purchasing and the 30% weight on patient satisfaction scores? If so,VBP only affects 1% of inpatient medicare revenue, so saying 30% of medicare reimbursements will be affected is vastly overstating the financial implications. 

    If not, is there another program that takes patient satisfaction into account and DOES implicate 30% of medicare revenue?

    • Steve Wilkins

      According to the provisions of the Affordable Care Act regulations, the program will be funded via a 1% withhold from ‘all VBS payments to hospitals.  That money — $850 million in the first year — will go into a pool to be
      doled out as bonuses to hospitals that score above average on several
      measures including HCAHPS patient experience scores. According to CMS, more than 3,000 hospitals will be affected. Under the proposal,
      patient scores would determine 30 percent of the bonuses, while
      clinical measures for basic quality care would set the rest.

      Hope this clarifies your understanding.  Here’s a link to more info: http://www.gpo.gov/fdsys/pkg/FR-2011-01-13/pdf/2011-454.pdf

  • http://pulse.yahoo.com/_KQQVQ6SJB6ERRWC2YP7MUTVNWI "Dr. Sam"

    Unfortunately, electronic medical records distract from the patient! And EMR end up containing a lot of superfluous fluff! … Dr. Sam Williams

  • http://www.facebook.com/people/Tariq-Ahmad/100000394918751 Tariq Ahmad

    As a former Primary Care Physician, and a Hospitalist for eight years (until I burned out), and now as a Pain management physician since the last several months, all I want to write is that the problem as I see it is not a lack of patient centered care in America. The problem is that the patients don’t care. Anyone in the trenches needs to simply ask their patients, are you taking your medications? Then and only then should you blame the Hospitals and Physicians for whatever it is you want to. We as physicians did not become physicians to kill our patients. An insult.

    This term “patient centered care” is a landmine, I wish someone would address this total lack of patient responsibility for their own care.

    • Steve Wilkins

      I encourage everyone with this perspective to ponder the following.

      1) Given that the average primary care physician spends less than 1 minute in talk time with patients when prescribing a new medication….including such topics as why they need the Rx, if the patient wants or will fill an Rx, contraindications, what to do in event of side effects, how to take Rx, etc. …is it any wonder that many are non-adherent?

      2) Given that physicians tend to overestimate the amount of information they give patients and underestimate the patient’s desire for information…is it any wonder patient are non-adherent?” 

      3) Given that Docs often do not encourage patients to ask questions about taking a new medication is it any wonder they may be non adherent? 

      The evidence in support of poor physician communications with patients and vice versa is very compelling.   I really believe that the real problem is a communications issue vs. a behavior issue.

      • http://www.facebook.com/people/Tariq-Ahmad/100000394918751 Tariq Ahmad

        I am absolutely flattered that someone would answer my comment.

        I only know how I practice Medicine. I re certified a year early and I  have post it notes in mydesk. Anytime I suspect that the patient is not going to remember what I have offered with regards to management or recommendations, I write it down and ask them to Google it . In pain management, it is even more important since everyone is getting the same medications. I have to keep it straight for myself too and that is when I discuss the medications and main side effects.

        It is a communications issue, and for some it is a behavioural issue. It starts with the acknowledgment that it is a problem, A major one. I am always available for my patients and one of their family members and I let them know it.

        This is between us and the ones reading this, what is anyone going to do about the goingson in all of America? I

  • http://www.facebook.com/people/Susie-Elliot/1740744713 Susie Elliot

    Medicare is basing 30% of its hospital reimbursement on patient emotional reaction to their hospital experience???
    Will it matter if they actually recovered?? I agree with Dr. Ahmad: “lack of patient-centered care” is not the problem…unless the patient doesn’t center on his own care.

    • Steve Wilkins

      Susie,

      What does patient emotions have to do with things like doctors or other providers failing to introduce themselves, asking patients if they understand how to take their medication or whether they their physician answered their questions??  Answer this question…do you feel you spend all your time trying to persuade your patients to follow your recommendations?    

  • http://twitter.com/IPFCC IPFCC

    Patient- and family-centered care is an approach to the planning,
    delivery, and evaluation of health care that is grounded in mutually
    beneficial partnerships among health care providers, patients, and
    families. It redefines the relationships in health care.

    Patient- and family-centered practitioners recognize the vital role
    that families play in ensuring the health and well-being of infants,
    children, adolescents, and family members of all ages. They acknowledge
    that emotional, social, and developmental support are integral
    components of health care. They promote the health and well-being of
    individuals and families and restore dignity and control to them.

    Please check out Tools for Change (FREE DOWNLOADS) at the Institute for Patient and Family Centered Care web site for self assessment tools to see how patient- and family centered your care is.