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Patient-Driven Care Instead of Patient-Centered Care

After being part of a discussion at the Institute for Healthcare Improvement today, I have decided to change my profile, above, from this:

Advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.

To this:

Advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.

What I am suggesting is that clinicians should do their best to collaborate with patients to understand their needs and desires and to jointly design plans of care that are as consistent as possible with those needs and desires.

I am not suggesting that patients take over the role of doctors and nurses. I also recognize that there are instances in which patients will be unable to communicate their needs. Then a double burden falls on the clinicians — not only to help cure those patients but also to do so in a manner that would be most sensitive to the likely concerns of the patients.

None of this requires clinicians to assume expertise that doesn’t exist on the part of the patients, or to give up their own moral or ethical beliefs or belie their training or experience. Instead, it suggests that, to quote e-Patient Dave, “Patient is not a third person word.” Or, as Charlie Safran said in 2004, “I want to note especially the importance of the resource that is most often under-utilized in our information systems – our patients.”

In short, it suggests a partnership between patients and clinicians that will allow both to do a better job in carrying out the healing process.

Simple? No. It requires mutual respect, intellectual modesty, a lack of entitlement, and a somewhat paradoxical combination of engagement and detachment that will be hard for both clinicians and patients to carry out. But the upside is huge, for both, if we can learn how to do it.

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

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MarieJenniferHMathewson, MD www.hubslist.orgVijay Goel, MD Recent comment authors
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Marie
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Marie

I fully support patient-driven healthcare. There needs to be more initiatives to engage patients in their heatlcare and make them responsible for their healthcare including what services are provided to them. The focus is on providers. The providers know what they are doing. It is the patients that don’t know and now is the time to get them involved and make them responsible for managing their healthcare. That is truly the missing link.

Jennifer
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Jennifer

You bring up a great point regarding patient care. However, as you’ve mentioned, it will not be a simple change to make. A clinician has to choose between doing what the clinician believes is best for the patient and doing what the patient wants the clinician to do, and sometimes this is not so simple. Regardless, I do agree with you that “clinicians should do their best to collaborate with patients to understand their needs…” In my opinion, I think this touches upon ethics at some point.

HMathewson, MD www.hubslist.org
Guest

Paul Levy, bless him, is such an articulate non-clinical speaker about clinical style, but alas, in this particular blog he seems to be “counting the number of angels on a pinhead” or ” tilting (again) against mythical windmills” . who could possible disagree with: “What I am suggesting is that clinicians should do their best to collaborate with patients to understand their needs and desires and to jointly design plans of care that are as consistent as possible with those needs and desires.” Hello, oh master of the obvious,who thinks that a one word change in his profile can make… Read more »

Vijay Goel, MD
Guest

Paul,
I think its a great distinction you make. There are however, a pretty substantial number of mindset shifts that have to happen to transition from “doing whats best for your patients” vs. becoming a trusted advisor to help your patients achieve what they think is most important for their lives.