Stanley Feld M.D.,FACP, MACE
Patient-Centered Healthcare is a new buzz phrase. It has become popular among Republicans in the last few years.
I have a feeling most people do not know what physicians mean by patient-centered healthcare.
The true definition is that patients are in the center of the medical care interaction. Patients determine their needs and their physicians. Patients drive the medical encounter. Neither the government nor the insurance industries drive the medical encounter.
A fatal floor in Obamacare was that President Obama wanted the federal government to control the healthcare system.
President Trump’s goal is to have patients in control of their own health and healthcare dollars. It is not a problem if the government or employers provide those healthcare dollars.
I believe Tom Price M.D. understands that the only system that will work is a system in which the consumers (patients) are responsible for their own health and healthcare dollars.
The government’s job is to provide incentives in the healthcare system for consumers to become responsible for their health and healthcare dollars.
I am not at all sure the Republican congressional leadership understands the definition or value of patient- centered care.
Obamacare provided just the opposite. Obamacare provided incentives for consumers/patients to be dependent of government.
This fundamental tenet of patient-centered care was tested by Stewart, et.al. in 2000.
Experts studied audio taped doctor-patient interactions while patients also rated these same interactions.
Expert opinion could not be correlated with positive results, but patient-perceived patient-centered care correlated with “better recovery from their discomfort and concern, better emotional health.
A Wikipedia definition of "Patient centered healthcare" does not exist. There are many consumer-driven healthcare definitions.
Most of the Republicans are talking about patient centered healthcare. However, they start and end with Health Savings Accounts and Consumer Driven Healthcare.
The American Association of Clinical Endocrinologist defined patient-centered healthcare in its diabetes guidelines of 1996 and 2002. (on request)
The guidelines were a System of Intensive Self-Management of Type 2 Diabetes Mellitus.
The Type 2 Diabetic was taught to become a “professor of his/her diabetes.”
The goal was to get the diabetic blood sugar as close to normal as possible. It was shown that normalizing the blood sugar helped avoided the vascular complication of diabetes. The treatment of the vascular complications of diabetes absorbed 80% of the money spent on diabetes.
Patients live with their disease 24/7. Blood sugars are very variable. Patients need to learn how to adjust to these variables by managing their medications and lifestyle.
Patients taking a pill or a shot will not control their blood sugar unless they understand the medication and how to adjust it to have the greatest affect on the blood sugar.
The only way a patient can understand how to control their blood sugar is for them to understand how their blood sugar affects the effectiveness of the medication and how their medications and lifestyle affects their blood sugar.
This same phenomenon applies to most chronic diseases.
The only way to decrease the complications of chronic diseases is for patient to drive the treatment of their disease.
This in turn will be the only way to control healthcare costs. This is what I mean when I say patients should be in control of their health.
As an added incentive to control costs, patients should be in control of their healthcare dollars so they figure out how to use medication most affectively.
“In 2001, The Institute of Medicine published a book called Crossing the Quality Chasm: A New Health System for the 21st Century.”
“In it, the institute identified six aims for improvement of healthcare delivery, one of which was “patient-centered care,” defined 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.”
The Institute of Medicine’s definition moves patients’ needs and attitudes toward patients being in the center of care. It does not place them as responsible for the management of their care. It does not include patients’ responsibility for their care.
All four of the endocrinologists got close to the definition of patient centered care. Only Carol Greenlee, MD, FACE, FACP, of Western Slope Endocrinology in Grand Junction, Colorado nailed the definition. Dr. Greenlee is the only physician in private practice.
“One of the most important things is partnership with the patient and what is called “contextualized” care, which means taking into account a patient’s needs and circumstances, goals and values.
It is also called developing a physician/patient relationship.
Another aspect is moving from the physician being at the center of the care model, with staff working to help the physician (doing tasks for the physician or other clinician such as “rooming” the patient or “scheduling” the patient for the clinician) to the staff also “taking care of the patient” as their job, with different roles on the patient-centered care team (getting the patient in for a needed appointment).
It is doing what is best for the patient (not giving the patient what they want, e.g. pain meds, MRI, antibiotics) or ask for (those things are not often best for the patient, but takes time to discuss through).
It’s taking our best science and knowledge and technology and then adapting it to meet the patient’s unique needs, circumstances, values, and goals.
It requires clearing up misconceptions (such as asking what the patient currently understands about a condition or a test or treatment), helping discuss risks and benefits in the context of that individual patient.
It requires asking not just telling, but it is not dumping everything back on to the patient.
It is taking into account the “work” (the job) of care (self-care that the patient or family need to do) on top of the illness and the rest of life that the patient and their family have to deal with and do (i.e. consideration)
Most clinicians think that they are already patient-centered because they care about their patients.
But that does not mean they provide patient-centered care or practice in a patient-centered approach.
I thought I was patient-centered because I cared but then I had to uproot my mental model to really become patient-centered.”
Republicans and their advisors do not understand the meaning of the concept of patient centered care.
Tom Price M.D. understands the concept of patient centered care.
Without the patient being in the center of the management of his/her care, the healthcare system can never be repaired and will never be financially sustainable.
I hope President Trump gets the concept in spite of the advice from congressional Republican and Democrats. Congress is trying to satisfy all the secondary vested interests. Healthcare is a big business with many secondary stakeholders. They do not want to lose this important profit center.
These stakeholders are better organized than patients or physicians to influence healthcare policy makers.
The primary stakeholders are patients with their head coaches and assistant coaches being physicians and their healthcare team.
Patients must be in the center of the healthcare team because they are the only ones that can influences the cost of medical care.
The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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