Call It Patient-Centeredness

I fear to become a patient.

What chills my bones is indignity. It is the loss of influence on what happens to me. It is the image of myself in a hospital gown, homogenized, anonymous, powerless, no longer myself. It is the sound of a young nurse calling me, 'Donald,' which is a name I never use - it's 'Don,' or, for him or her, 'Dr. Berwick.' It is the voice of the doctor saying, 'We think...,' instead of, 'I think...,' and thereby placing that small verbal wedge between himself as a person and myself as a person. It is the clerk who tells my wife to leave my room, or me to leave hers, without asking if we want to be apart.

That's what scares me: to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife's hand, to eat what I do not wish to eat, to be named what I do not wish to be named, to be told when I wish to be asked, to be awoken when I wish to sleep.

Call it patient-centeredness, but, I suggest, this is the core: it is that property of care that welcomes me to assert my humanity and my individuality. If we be healers, then I suggest that that is not a route to the point; it is the point.¹

A close friend shared a paper with me recently that says a lot about what health care should be all about. The paper is titled "What 'Patient-Centered' Should Mean: Confessions of An Extremist" and was written by Dr. Donald M. Berwick, president and chief executive officer of the Institute for Healthcare Improvement in Cambridge, Mass. The above is an excerpt from the conclusion of his exceptional work.

Dr. Berwick's comments are largely directed at the health care community, but they hit home with me as an individual. As our mothers get older, my wife and I are both gaining greater exposure to the medical madness many seniors experience.

The concept of "patient-centeredness" is not foreign to most doctors of chiropractic. It is likely that you practice this to some degree every day. Hopefully, you know your patients as complete people with personal needs, family issues and life challenges, not just as patients with symptoms and conditions to be treated and sent on their way. Like myself, you are probably frustrated at the lack of concern the medial process seems to have for wellness. Managed care has only made this worse - much worse.

In his article, Dr. Berwick offers three maxims for patient-centeredness that have been presented by others, but clearly deserve repeating, particularly as health care reform progresses with apparent emphasis (at long last) on patient-friendly care: 1. "The needs of the patient come first." 2. "Nothing about me without me." 3. "Every patient is the only patient."

While these may seem obvious to you as a doctor of chiropractic, they clearly aren't standard practice in the medical realm, at least not yet. Dr. Berwick's 11-page paper is filled with examples of people receiving care from a system that shows little regard for the person.

The chiropractic profession finds itself in the midst of a paradigm shift in thinking within the health care arena. We see practitioners, policy-makers, the public and other health care stakeholders in the United States (and perhaps the rest of the world) adopting positions that are ever closer to our chiropractic philosophy.

The question for us is this: How do we help the concept of patient-centeredness move forward within the medical establishments in our own communities? Can we encourage our patients to expect - no, to demand - this level of care from all of their health care providers? Can we discuss the issue with other providers and help them understand the value of this approach? And what can we do to foster patient-centeredness in every interaction we have, such that others learn what we have known for so long?
Dr. Berwick is well-known in many medical circles. Most medical providers should be familiar with the Institute for Healthcare Improvement. His direction for us and all providers is very clear and, in my opinion, deserves immediate attention:

For better or worse, I have come to believe that we - patients, families, clinicians, and the health care system as a whole - would all be far better off if we professionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives. I suggest that we should without equivocation make patient-centeredness a primary quality dimension all its own, even when it does not contribute to the technical safety and effectiveness of care. 

Reference

1. Berwick DM. "What 'Patient-Centered' Should Mean: Confessions of an Extremist." Health Affairs, 2009;28(4):w555-w565.