Patient centered care starts in medical school

For thousands of first-year medical students, including myself, last week marked the beginning of classes and our official entrance into the medical profession. We sat through lectures on the normal functions of the body, and many of us even set foot in the gross anatomy lab for the first time.

At my school, we didn’t just delve back into the basic sciences—on day two, we also began a class that will teach us the foundations of clinical medicine. I don’t doubt that many schools include this kind of instruction from the onset. The subject of our first session: Patient-centered care.

For a lot of my classmates, I think the topic may have seemed irrelevant at this point. After all, we won’t see actual patients for awhile. It may also have even seemed obvious. Of course we will practice “patient-centered care”—that’s the whole reason we’re here, isn’t it? The only reason we have a health care system at all is to take care of patients.

Maybe it’s because of the time I spent working in health policy before medical school, but this struck me as the most important material covered all week (sorry, central dogma).

Knowledge of the basic sciences and the pathology of disease is necessary to treating patients, but it isn’t sufficient. So it goes, too, with learning the proper way to interview patients (another topic which may have seemed a little obvious to many of us—yes, of course you ought to demonstrate empathy for your patient’s concerns). You can’t be a doctor without this knowledge, but it by no means guarantees your patients will experience patient-centered care. It’s certainly not the only thing that will shape our careers and the kinds of decisions we will make every day.

There’s a third crucial component to patient-centered care, and it may be the most important. It means the difference between succeeding or failing at promoting health and wellness, alleviating pain and suffering, and curing disease whenever possible.

What I am talking about is the system we’re working in. Not only is it the most important, but it may be the one component shifting further and further out of physicians’ hands.

Every medical professional must recognition that the Affordable Care Act will drastically change the way medicine is practiced in theUnited States. If it is repealed and replaced with another direction of health care reform, that, too, will affect our practice.

I would never presume to know more about medical practice than my peers—after all, we are in this together, and it all started just last week. I only entreat my fellow classmates to pay close attention to this idea of “patient-centered care” from the get-go. It’s a term that is used a lot, especially by politicians, to mean very different things. But for doctors, the implications are clear. The needs of our patients—the actual, individual patients standing before us—come first. As the future of the health care system shifts, practicing and future physicians who understand and refuse to abandon this simple principle must lead the debate.

Kathryn Nix is a medical student and former health policy analyst at the Heritage Foundation. 

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

    You spend very little time actually elaborating on what you mean by patient-centered care. To say that it means that “A patient’s needs come first” is merely to replace one bumper sticker for another. Which needs?

  • James deMaine

    50 years ago as a medical student, our Chief of Medicine brought a patient into the lecture hall to discuss. He said, “Today I’d like to present a very interesting case to you.” Then he paused as we began to pay attention saying, “Now I’ve just made two serious mistakes – what are they?”

    He pointed out that the term “case” tended to dehumanize the patient and “interesting” tended to ally us with the disease rather than the patient. This all generated a lively discussion but I never forgot the lesson. The meaning of patient-centered care has expanded to such things as shared decision making, preventive care, palliative care, family centered care, etc. It’s an old lesson in medicine that we all need to remind ourselves of. See http://www.kevinmd.com/blog/2011/07/secret-caring-patient-care-patient.html

    • carolynthomas

      What a profound and memorable lesson your chief taught in that lecture hall! Thanks so much for that story. I can tell you as a heart patient who’s become a frequent flyer in our health care system that there are many of your peers now practicing who could have benefited from such a lesson!

      For too many of us patients, based entirely on how we are dismissively treated (or ignored entirely by staff chatting over our heads about their weekend plans), it’s easy to feel like we are merely “Bed 8″, or the 10 o’clock procedure, or just the obstacle between hospital staff and their upcoming coffee break – instead of a real live human being lying there sick and afraid.

      Thanks also Dr. DeMaine for including the link to your previous post here. Very moving story – a “must-read” for all physicians.

  • http://twitter.com/GoldCareInMed The Gold Foundation

    We are glad to see that the notion of treating the whole person was something introduced during your first week of medical school. The Arnold P. Gold Foundation, the relationship believes that the relationship a physician has with their patient must be as humanistic as it is technically competent. We would include the qualities of integrity, excellence, compassion, altruism, respect, empathy and service as part of humanism. If you received an Gold Foundation “Humanism in Medicine” lapel pin as part of your White Coat Ceremony, we hope you will wear it daily as a reminder to remain patient-centered and humanistic throughout your training and into practice.

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