Posted on November 7, 2017

At MedPro, our focus is on providing focused and reliable solutions to health care providers at predictable rates. In this article we take a look at patient centered care. We dig into the definition and key tenets. We also look at the science behind seemingly airy topics like empathy and relationship building, and how they can actually improve treatment and enhance recovery. Finally, we provide videos and examples of patient centered care that illustrate the core of this at times slippery concept.

What is Patient Centered Care?

Patient centered care is the idea of basing all health care decisions on the needs of the patient. While that may seem like nothing new, in fact the definition of patient centered care runs contrary to current practices. Our system of regulation and profit often puts the needs of the facility (or the rulebook) first, leaving patient needs a distant third. For example, an allergy sufferer may come in wanting to understand her condition and prognosis. Instead, she may be rushed through a barrage of office visits, testing, and steroid prescription. Her frustration paradoxically goes unnoticed by the system that created it. Patient centered care seeks to turn this situation on its head, to start with communication, empathy, and relationship first. Treatment proceeds only from there.

The Core Principles of Patient Centered Care

There are eight core principles of patient centered care, as defined by the Picker Institute. The Institute was founded by Harvey Picker in the late 1980s after his wife Jean suffered a debilitating illness. The couple found the U.S. medical system strong on clinical ability but short on humanity. The institute sought to correct this flaw, which it sees as ultimately hampering the success of health care at large. The tenets of patient centered care are:

  • Respect for patient values, preferences and expressed needs. This means keeping patients informed and involving them in their own health care decisions.
  • Coordination and integration of care. Health care can cause many different stakeholders to interact directly with a patient. These team members should coordinate their efforts to present a united effort.
  • Information, communication and education. Special care should be taken to explain and educate diagnosis and treatment, and to learn patient expectations and concerns.
  • Physical comfort. Pain management, assistance with daily activities, and respecting patient privacy all contribute greatly to patient satisfaction.
  • Emotional support and alleviation of fear and anxiety. Addressing anxiety over illness and treatment can be as important as addressing the illness itself.
  • Involvement of family and friends. Family and friends should be welcomed and treated with respect, especially in their role as patient advocates.
  • Continuity and transition. Before discharging a patient, the facility should make sure the patient understands all needs for medication, diet, continued therapy, and similar concerns.
  • Access to care. Barriers to care should be removed, creating convenient locations, transportation, scheduling, and access to specialists.

This video from the Hawaii Medical Service Association gives a great, fast overview of patient centered care.

Is Patient Centered Care too Touchy Feely?

The concept of patient centered care may seem overly esoteric. The ultimate goal of medicine is to make people well. The idea of building a relationship, expressing empathy and caring, and focusing on communication can seem like expensive window-dressing. In fact, the evidence shows that placing emphasis on these apparently ephemeral concerns actually leads to better recovery and improved patient satisfaction. That in turn creates a more efficient and effective health care system at any scale.

Empathy and Recovery

According to a study presented to the American Academy of Orthopaedic Surgeons (AAOS), physician empathy leads to better outcomes for care and higher patient satisfaction. This means patients treated with more empathy may actually recover faster. Empathy doesn’t heal patients through some magical pseudo-scientific means. Rather, it aligns the patient with the physician, improving compliance with medication instructions and therapy orders. It causes less mistakes and fewer malpractice cases. Empathy, far from a spooky faith-healer trick, is really just a science-backed means of enlisting the patients’ aid in “rescuing themselves.”

This moving video from the Cleveland Clinic shows the need for empathy in a way that goes beyond words.

Why Relationship Matters

In a recent patient satisfaction study, the biggest cause of frustration was the failure of physicians to explain diagnosis and treatment. The provider-patient relationship goes beyond just making patients feel good about shelling out money in exchange for treatment. Relationships put patient and provider on the same wavelength. A patient who feels a connection to a health care professional is more likely to be open about symptoms, situation, and challenges. She’s more apt to contact the provider when care is needed, or with questions to avoid making mistakes. Patients who trust and respect their doctors are more likely to follow orders and feel comfortable being a part of the healing process. In short, a relationship turns a patient from a supplicant or customer to an active team member of the health care team.

This excellent, short video from Dan Berwick explains the need for patient centered care from the patient’s point of view.

Patient Centered Care Examples

The following examples put patient centered care in concrete terms.

Patient Centered Care Example #1. A patient enters a psychologist’s office complaining of depression. With each session, the psychologist takes the traditional approach of guiding the patient to talk about his sources of distress. She gets him to examine his beliefs about these worries. She also prescribes medication. However, in a patient centered move, she refers the client to a local support group. She recommends listening to podcasts and audiobooks on awareness and happiness. She points the patient toward local exercise clubs and counsels him to use wearable technology to track fitness goals. These techniques foster patient wellness, rather than focusing on what the doctor can do for the patient.

Patient Centered Care Example #2. A patient in a dentist’s office suddenly complains. He’s frustrated that every year, he pays $200 for a periodontal cleaning. It’s not the price that bothers him, but rather, that the hygienist lectures him with each visit for not flossing properly, and consistently suggests he drink less coffee. After a discussion, the hygienist observes the patient’s flossing technique and confirms that he does in fact floss correctly. Further, she makes a note in his chart that he’s not a coffee drinker. The hygienist consults the periodontist, and together they determine that the patient experiences more staining and tartar buildup for innate physiological reasons. The patient’s file is changed so the hygienist no longer counsels him on flossing or coffee drinking.

Patient Centered Care Example #3. A physician takes a few minutes to understand a patient’s concerns with finances, working two jobs, and diet challenges. He admits the patient faces serious hurdles to getting well. He refers the patient to a fitness coach who works with the patient’s hectic lifestyle to introduce and maintain more healthy choices. During subsequent visits to the same doctor, the patient continues to feel heard and understood. As a consequence, he adheres more strictly to his diabetes medication regimen.

Here’s a 20-minute TED Talk that explores patient centered care from the point of view of Dave Moen at TEDxUMN.

Conclusion

This article provides an overview of patient centered care, including its definition and key principles. It explores why concepts like empathy and communication are so much more than just “good ideas” to make a patient feel good. In fact, the science shows that empathy, communication, and solid provider-patient relationships can align the patient and the health care pro. This forges them into a team with concurrent goals, and ultimately fosters better patient adherence to medical instruction.

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