As with last week’s post on shared decision-making, the goal of patient-centered healthcare is pretty straightforward conceptually, but harder to execute. But, why wouldn’t healthcare have started out as patient-centric? Wasn’t the whole point of healthcare to help the patient?
Well, yes and no.
Until recently, both patients and providers thought that it was the providers who knew best, and the way insurance evolved was to pay providers based on volume of care, otherwise known as the fee-for-service model. The more patients you see and the more procedures you perform, the more you get paid. Little thought was given to discussing options to determine what would best serve the patient’s needs. And patients accepted that.
But in the last couple of decades, the understanding of what constitutes expertise has been changing --not all for the better, but some. When it is for the better, expanding what counts as expertise primarily consists of both patients and providers slowly coming to the realization that patients do hold a certain kind of expertise – in how their individual bodies deal with their (diagnosed) conditions.
Though a provider is an expert in the science of a condition, every body reacts in its own way. Often, there are trends that are common enough that they can be quantified, and constitute an expected norm. Other times, even if a condition is following what’s expected and treatment is successful, a body can react with unexpected side effects. I say that as someone who had a bad treatment reaction that occurs only in 0.3% of patients who take that treatment. I had been complaining to my parents that my brain was having trouble finding words and that it felt like a glitchy computer since my providers had started aggressively ramping up my dosage. When the dosage was maxed out, it gave me a grand mal seizure. No provider would have thought, “Oh, she’s having X reaction, it must be this drug.” It’s too remote a possibility and most providers would never have heard of that particular side effect. I knew what it was, though. It took my psychiatrist looking it up in the Physicians’ Desk Reference to confirm it.
Without having a conversation with my psychiatrist, who was open to the idea that I might know something my doctor didn’t, it would have taken a lot longer to figure out a dangerous problem like how my brain was reacting to this medication. It should have been my doctor, but the one I was seeing at the time wasn’t so open to that philosophy of treatment. Of course, that was almost 25 years ago.
Right now, these cookie-cutter approaches are contributing to inefficient care that makes us sicker than we have to be. The thing is, when you employ patient-centric methods such as whole person care, integrated care, and continuity of care, treatment is more likely to fit the individual patient’s needs, as well as result in a higher level of participation in agreed-upon regimens. Higher rates of participation inevitably lead to better outcomes, i.e. healthier people. Oh, and healthier people equal lower costs along the lines of that old adage, “an ounce of prevention is worth a pound of cure”. (For chronic and autoimmune patients, “cure” means stability.)
Sounds good, right? Right. But it is a paradigm shift. Providers will have to start viewing patients as colleagues and not clients. In my experience, even some providers who recognize the value of a patient-centric system still fall into paternalism when they are looking for ways to achieve it.
That means that we patients have some work to do. In order for changes like this to happen, we have to make sure we are having conversations with our providers and speaking up about what we want, especially if it isn’t what the doctor recommends. It will be hard for some of us – it will feel unnatural. But the more we do it, the easier it will be.
Even then, until a majority of stakeholders (insurance, pharma, hospital systems, providers, governmental regulatory bodies) turn a corner, we will have to shuffle toward progress rather than stride. But shuffling is still moving forward.