Monday, January 6, 2014

What Is Patient-Centered Medicine, Really?

We have all heard the term patient centered medicine by now.  It's in the PR materials for hospitals, in the Accountable Care Act, in health care model innovations like the "medical home" and the "accountable care organization."  But what is it?

One doctor I know would mumble, whenever anyone said the phrase patient centered care  - "Yeah, centered around us."  It seems that doctors and hospitals, in trying to design more patient centered care can't help thinking like doctors and hospitals.  Some patient friendly changes have happened.  They let friends and family stay overnight in the patient's room.  They bring in trained Reiki specialists to do hands-on energy healing for patients.  They ask about your pain level as the newest vital sign to measure.  The practitioners -- doctors, nurses, physical therapists, social workers --- and the front desk people are as dedicated and hard-working as ever.  Some of them have gone through service excellence programs like the ones they do for Hilton hotel employees.

But - you are a still considered to be a patient, not a customer.  Imagine what would be different if we were customers?  Think about Amazon, Apple, Zappos.

We still have to go to brick & mortar buildings, even though technology could allow us to stay at home more and be monitored for many conditions - blood pressure, insulin levels, weight.  When my husband and I were traveling I noticed an painful, reddish bump on my arm.  Instead of spending hours in a nearby emergency room, he took a photo of the bump and sent it to a friend who is an emergency room doctor.  Our friend said we could wait until we got home to have it looked at.  This kind of visual/verbal distance assessment and treatment are happening - but they are the aberration, not the norm.

We still have to wait to be seen, sometimes months.  Just ask for a referral to Dermatology.  What other industry, including knowledge-based ones, makes you wait months to receive your product or service?

And after we are seen, we are largely forgotten.  I am still getting periodic emails a year after I visited a car dealership.  The only doctor I got a checking-to-see-how-you're-doing call from was an endodontist who did a root canal.  It's the in-between-visit time that determines our health, not the 15 minutes spent in the exam room.  And no one is watching over us then.

I am not complaining.  I am comparing.  And wondering how a health care system designed with patient inclusion would function.  And yes, places like Kaiser and the Mayo Clinic have included patients in design work.  And they do have more hospitable (pun intended) exam rooms and waiting rooms; and patients and family are kept better informed.

But that's not all of it, is it?

When I speak at health conferences or community centers, one of the points I make is that in order of healing  power first came my husband, then my dog, then all the terrific practitioners who helped me return to a full life.

What if instead of asking what patient centered care looks like, we asked, "What is at the center of the patient's world and how can we design so that the patient's natural supports are a vital part of the treatment?"

I wonder......

Here's one place that has moved in this direction:

"Southcentral Foundation's "Nuka System of Care" is a name given to the whole health care system created, managed, and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness. The relationship-based Nuka System of Care is comprised of organizational strategies and processes; medical, behavioral, dental and traditional practices; and supporting infrastructure that work together - in relationship - to support wellness. By putting relationships at the forefront of what we do and how we do it, the Nuka System will continue to develop and improve for future generations."

What would you like to see in a health system that is truly patient centered?

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