Shuffling Toward Patient-Centric Care

Photo credit:  INOVA

Photo credit: INOVA

Dr. Stephen Clement was my first endocrinologist out of college. He has been an Army doctor, a fellow at the Joslin Clinic, the head of diabetes program at Georgetown University, and is the architect of the (fairly) new inpatient diabetes program for Inova Fairfax Hospital in Virginia. I’m sure there’s more. Almost 20 years ago, he started teaching me how to be my own advocate. I recently sat down with him to explore how he came to be a patient-first doctor in a generation where such providers were few and far between.

There will always be patients who need for their providers to be the ones in control, but patient-centric models of care are becoming more and more in demand. So, how do we get there? One of my endocrinologists has been at the forefront of patient-centric care for decades. How do we make Dr. Clement’s approach the default?

It has to be both sides working together. The providers he works with are passionate about working with diabetics. It can be a Sisyphean task sometimes – the same conversations with the same patients over and over – but he sees the providers’ job as supporting the patients in the ways that they need. Not just in the periodic appointments, but when something happens or questions come up in the interim, too. Maybe a new treatment isn’t working or they have new symptoms. Patients shouldn’t wait to ask for modifications and providers should be willing to have a conversation – maybe there hasn’t been enough time for the new treatment to work or maybe another treatment would work better.

As for patients, speaking up can be intimidating, but the patient needs to be comfortable with a treatment for it to be effective. Dr. Clement says to be yourself, but be assertive. It may take a little homework, but know what you want and don’t be afraid to say no to something you don’t.

He also suggests that patients have a list of things they want help with (I am notoriously bad at this—I never even bring a record of my blood sugars.), and think about what your priorities are. Walking in saying “fix me” to a provider is not helpful. They don’t know where to start and figuring that out takes time better spent on specifics.

Patients (we) also have to take responsibility. Providers can’t “fix” us. They can’t give us our insulin shots. They can’t portion out our food. It’s easy to let them take care of us, but that also makes it easier for us to blame them when we don’t follow our regimens and our lab results aren’t what we want them to be.

The bottom line is that it’s going to take effort on both sides for patients to achieve the parity we deserve in patient-provider relationships, but the results speak for themselves. We deserve that.

Next week, Dr. Clement talks about what the future of healthcare might look like.