Understanding what patient centered care really means

There was nothing the professor despised more then the syrup that oozed out of his partner’s lips when dealing with patients. He often cringed as he walked by the examining room and imagined the hand holding that was taking place behind closed doors.

Privately, they argued about the different approaches. One saw the world in terms of black and white, while the other was steeped in a foggy haze of gray. The professor felt that patients needed to be scolded and prodded into the preferred direction. He heard the rumblings of patient empowerment and had quite a cackle in the physicians lounge with his like minded colleagues.

If they are so empowered, why do they come whining to us?

The professor had no problem laying down the proverbial law to his patients. In fact, it was during one of these impromptu brow beatings of a young lady with morbid obesity that he felt the first twinge in his chest. It was fleeting like a wisp of air that came and went by the time one was able to think about it.

The professor dismissed such symptoms. He was healthy to the bone and wouldn’t let such musculoskeletal aches and pains bother him. As the days passed he randomly rotated his shoulders and expanded his chest in order to recreate the discomfort he felt in the exam room. If he could reproduce the symptoms then surely it must not be his heart. But nothing happened.

A few days later a sharp stabbing thorn pierced his sternum while talking on the phone with a colleague. The professor almost dropped the receiver but recovered when the sensation dissipated. As the day progressed, the pains began to increase. They came more frequently and lasted longer.

The professor muddled to rationalize his symptoms as something benign (a process which he would have highly criticized in one of his patients). He tossed and turned in bed till midnight before finally falling asleep. He awoke an hour later in a panic. He felt a crushing pressure over his chest and he gasped for air. He reached over to pick up his cell phone.

Hello 911 … I’m having a heart attack!

***

The professor was convinced that his ride to the emergency room would be his last tenuous grasp on a life cut short in its prime. But with a little oxygen and nitroglycerin, his pain abated.

When his partner waltzed into the exam room at three in the morning, the professor felt a moment of embarrassment before relenting to the overwhelming sense of relief. There was not a trace of mocking in his partner’s voice.

You had me scared there for a moment, I hope you don’t mind that they gave me a call.

He placed his hand on on the professor’s gowned shoulder and then began to examine him. Later he sat in a chair next to the gurney and reviewed the options. To his great surprise, the professor didn’t mind being treated like and ordinary patient. He felt strangely taken care of and glad to have his doctor illicit his opinion.

They eventually decided on a short stay in the hospital and a nuclear stress test the next morning. The professor fell asleep peacefully as he waited for his bed on the telemetry unit.

***

The stress test showed no signs of heart disease. It appeared that the professor was more likely having a panic attack. After dressing to leave the hospital, he sat a few moments with his partner who was preparing the discharge paperwork.

He looked appetizingly at the man standing in front of him. What once evoked anger and sarcasm now seemed almost angelic. He had come to understand what patient centered care meant. The idea was to place the physician and patient on the same level. There was no need for power inequality.

To his great surprise, he had become an empowered patient. Not by his own knowledge or abilities, but rather by the respect and dignity afforded by his colleague. He had been both assured by his physician, but also allowed to participate in his own care.

On that day he vowed that he would no longer be the professor.

He would be a student, a student of human nature.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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  • http://pulse.yahoo.com/_KL7PN5P3632TBOUFWJQY6HGJKI Maggie

    Jordan–

    An wonderful illustration of what patient-centered care means.

  • Anonymous

    I wonder whether it wasn’t a coronary artery spasm rather than a panic attack. I had one in 1992. I woke up at 3 AM from a sound sleep with SEVERE chest pain, a heart rate so rapid I couldn’t count it, light-headed and with cold sweats, and I went to the bathroom, and passed out on the way back. When I woke up, the pain was gone, but my PCP sent me to the hospital, since I had passed out. My own new cardiologist took me seriously and has treated me with calcium channel blockers ever since, but the other cardiologist on call tried to tell me it was a panic attack. Why in the world would I have a panic attack out of a dead sleep when I never ever did before, and never have since? I HAVE, on the other hand, had another spasm, and there is a small scar on my heart. I’m very grateful that I have a good, and as you say, patient-centered cardiologist!

  • Anonymous

    Great story.

    Of course, in an official NCQA-certified Patient Centered Medical Home, the professor’s care would have been entirely delegated to non-physician members of the team, freeing up his partner to sit of front of the computer doing data-processing chores. Personal relationships over time between physician and patient are considered to be absolutely meaningless in this new model of care. No wonder patients and doctors hate it. 

  • Steve Wilkins

    Great story – eliminating the “control” barrier between physicians and patients is only the firsts step to becoming “patient-centered.” .  Now the professor needs to learn how to put his new found religion to work for him and his patients – that means learning how to integrate patient-centered communication techniques into his dealings with patients. 

    Steve Wilkins
    http://www.healthecommunications.wordpress.com

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    Patient-centered care that is a shared decision making between patient and physician will lead to better results for those with chronic diseases, I believe.  As Southerndoc1 commented, this care is not always provided by the PCP or other physician.  Sometimes other staff provide necessary services. 

    I read recently about the advent of Lifestyle medicine (http://commonhealth.wbur.org/2012/02/doctors-lifestyle/) in which both the patient and physician work to achieve a healthy lifestyle.  This orientation to medical practice is being taught at Harvard Medical School.  It seems to be an extension of the PCMH.  I hope that you readers find time to read the post.  Quite enlightening.

  • Anonymous

    Patient-centered care means we put the patients (not consultants and experts) in the center of designing their own medical home: http://www.idealmedicalcare.org/     

  • Anonymous

    Try contradicting that unctious doctor, his true colors will come out. For example, my EKG has been normal for 3 hours, my enzymes are normal. I have a history of GERD. I am walking out and not generating massive expenses with pointless admission and testing. Nor do I want a nuclear test. I want an immediate stress echo.

    See what happens to the charm of that “angel” of mercy.  It is not much of a test of personal medicine to completely obey a doctor acting in his own economic self-interest. The test comes in a disagreement.