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What Does “Patient-Centered” Really Mean?

Posted Mar 08 2014 10:02pm

Posted on | March 5, 2014 |

  MICHAEL MILLENSON

Health Commentary contributor, Michael Millenson, recently published an important paper in the Journal of General Internal Medicine titled “New Roles and Rules for Patient-Centered Care”. It provides abundant food for thought, and it deserves a careful reading.

Here are a few excerpts:

THE GOAL: “Certainly, ‘patient-centered care’ was not the goal originally pursued by patients: what they demanded was shared power.”

CONSUMERISM: “In contrast, consumerism springs from different soil, involving purchasing decisions based on the perceived value of what is being sold.

THE PROBLEM:  ”Nonetheless, the casual use of ‘patient’ and ‘consumer’ as interchangeable terms is problematic…For example, when a ‘consumer’ chooses a doctor using price and ratings information, she trusts that caveat emptor will not replace primum non nocere when she walks into the exam room as a ‘patient.’ Should she, or should market- place rules prevail? When a doctor recommends an expensive test, how should a ‘consumer’ respond to ‘drive value improvement,’ in the IOM’s phrase? Might that differ from how a sick and vulnerable ‘patient’ would behave? Is consumer satisfaction (“my money’s worth”) really identical to patient satisfaction?”

THE DIFFERENCE: “I believe that what distinguishes patient-centered care in its fullest sense from beneficence or better customer service is that it involves actions undertaken in collaboration with patients, not just on their behalf. It requires clinicians to appropriately share power even when that sharing feels uncomfortable.”

THE POWER: “The problem here is not the absence of a ‘prepared and engaged patient,’ as the IOM would have it, but power: who is engaging whom on what terms? Similarly, the right to shared decision-making has historically been bestowed on patients. As clinically relevant data are increasingly generated and controlled by patients, who is sharing decisions with whom?”

THE SOLUTION: “The IOM erred. ‘Prepared, engaged patients’ are not the fundamental precursor to transforming health care. Patients and providers alike must change. What we need is not better patients, but a framework that enables a far deeper partnership.”

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