What is patient-centered care?

Patient-centered care was included in the Institute of Medicine’s Quality Chasm report and insurance payments are increasingly linked to the provision of patient-centered care. As clinicians, there is a deep respect for patients and an obligation to do things on their terms and honoring their wishes for their healthcare plan. Patient-centered care is an approach to care. There are at least three players in making patient-centered care happen: Clinicians: Clinicians need to help patients be more active in the clinical encounter, because this might be a role that is new to them and does not feel comfortable. Individuals with serious mental illness are particularly challenged by being active in the clinical encounter due to symptoms of the disorder (e.g., paucity of words, affective flattening, cognitive deficits). Additionally, many patients have a long history with a medical system that has been paternalistic, rather than a partnership.

To encourage a patient-centered clinical encounter, clinicians might say: “I want to make sure the plan we have fits with what you want. Most individuals usually have an opinion on this and have questions. Can you tell me what you see as important in what we discussed today? Where can we improve our plan?” Then, patient treatment preferences need to be included in the patient’s treatment plan with regular required updates. Patients: Patients need to advocate for what they need to meet their short- and long-term goals. This might mean a focus on rebuilding family relationship over and above losing weight; or it might mean moving to a medication with less weight gain potential with more frequent medication management visits during the transition. What they decide as treatment preferences and priorities need to be expressed often, to all on the care team, and revisited regularly. Organizations: Organizations need, as much as they can, to unburden frontline clinicians from demands that can be completed by other staff in order to provide more time in the clinical encounter for discussions with the patient (e.g., move from “assembly-line” medicine to patient-centered medicine).

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