The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”
Based on that definition, of course all health care should be patient centered. However, it’s not even close and likely never will be. Patient Centered Care will require ‘buy in’ and change of practice at every level, from governments, health authorities, doctors (a massive stumbling block as they are not taught patient centered care), and nurses (who are taught what it means and how to deliver it but quickly learn there is not the time or money to implement it).
In order for patient centered care to work, every health care provider (nursing at all levels to physicians at all levels) will have to be accountable, be willing to give every patient the time they need, be empathetic, be teachers and listeners. Patients will have to be accountable (wherever possible) and work at improving their own health outcomes and give up the idea of handing over their health to the healthcare system.
Doctors, nurses, hospitals, health authorities bring up the term “Patient Centered Care” time after time. In February 2015 a very lofty document, British Columbia Patient-Centered Care Framework from the BC Ministry of Health was released:
Providing patient-centered care is the first of eight priorities for the B.C. health system as articulated the Ministry of Health’s strategic plan, Setting Priorities for the B.C. Health System (February 2014). Under the strategic plan, the province will strive to deliver health care as a service built around the individual, not the provider and administration. This is not an overnight change, but a promise of a sustained focus that will drive policy, service design, training, service delivery, and service accountability systems…
Patient-centered care puts patients at the forefront of their health and care, ensures they retain control over their own choices, helps them make informed decisions and supports a partnership between individuals, families, and health care services providers. Patient-centered care incorporates the following key components:
- shared and informed decision-making;
- an enhanced experience of health care;
- improved information and understanding; and,
- the advancement of prevention and health promotion activities.
Patients, families and caregivers are partners in health care, supported and encouraged to participate in:
their own care
decision-making about that care
choosing their level of participation in decision-making
quality improvement; and
health care redesign.
I shared this definition with my client Jill* who is young, intelligent, and incredibly empowered and has faced road blocks and doors at every turn as she has tried to be a partner in her own care.
Jill developed a serious and life-threatening infection following surgery – the latest battle she has fought after years of having her symptoms and concerns being dismissed. Despite the gravity of her current situation, she is still encountering doctors and nurses who are dismissing her concerns, no matter how grounded and well-researched the information she brings to the discussion.
She laughed as I read the definition to her. She should be the poster-patient for patient centered care but not a single one of these guidelines have been a part of her care. But, today, she used the term with a nurse who was dismissing her concerns (again). Jill said, “I’m asking for patient centered care.” And the nurse’s attitude changed abruptly. I invite every patient to do the same.
It is my opinion that Patient Centered Care will never be implemented, ever, within our healthcare system for the following reasons:
- Governments (Federal and Provincial) continue to try and ‘hold the line’ on increasing health care costs as our populations rise and the numbers of seniors grow exponentially. Healthcare already uses 42% of the annual provincial budget.
- In reality we don’t have health care, we have crisis management. Virtually all preventative and collaborative care has been eliminated from coverage under the medical services plan. This means that patients are already sick when they enter the system and likely already disempowered when they reach the acute health care system and unable to effectively speak up and be a part of their own care.
- There are not enough doctors to make patient centered care a reality! General Practitioners (GP) are paid $30 per visit. They’re already over worked. Doctor’s don’t have time to collaborate with their patients and share decision making. Currently 70,000 British Columbian’s don’t have a GP and walk-in Clinics are being forced to ‘take on’ all patients walking through their doors and will be facing stiff penalties for not complying. They now have to take complex patients and can’t be seen to pick and choose. So, on top of all of that, we’re asking them to sit down with their patients and give them the information they need to make the best choices possible? I think not.
- Doctors are not taught to collaborate with their patients. They barely collaborate with each other. While I have encountered doctors who are exceptional and who listen to their patients, they are rare (in my jaundiced eyes). Most doctors ‘know best’ and there is a lopsided power relationship that will not be easily unlearned.
- Nurses are no longer (for the most part) caregivers. They are extremely knowledgeable workers who move quickly from task to task, crisis to crisis, and rarely a moment to talk to their patients. For the first 20 years of my career as an RN, above all else, I was a caregiver and teacher. But my way of nursing was squeezed out as the patients became more and more acute and the patient workloads became unmanageable. In today’s healthcare system, there is little time for the most basic of teaching clients how to best manage their care at home, let alone to sit down with patients and families and collaborate on their needs and care. And, because there is no time, patients are no longer given choices in their care and their voices are not heard. This is only going to get worse – unless governments are willing to infuse massive amounts of money in training and hiring nurses and then reducing their workloads so they can give patients quality time.
- Due to cost, health ‘care’ is being relegated to nursing care aides who are not trained to be a part of the teaching and collaborative process. On many hospital medical units and in long term care units, patients will see their nurses only when medications are being administered or if treatments are required. How can patients and families collaborate in their care when they rarely see a nurse and only for moments at a time?
In the long run, patient centered care is better for patients, healthcare providers and governments – but the cost to implement such radical reforms would be a massively costly proposition. As patients, we’ve got to keep trying to make these changes – but rather than from a top-down approach, making it from a grassroots level – the only kind that’s ever, truly effective.
Keep up doing your research, keep asking to be heard, and keep demanding to be a part of your health care decisions because it is your health and your life.