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Who gets to say that Healthcare is Patient Centered?

October 23rd, 2012 Leave a comment Go to comments

Patient engagement and Patient Centered Care are buzzwords and trendy goals of primary care doctors, Hospitals and other providers these days. I will attend a meeting with PCORI, or Patient Centered Outcome Research Institute starting on Friday. Before I go and absorb what the other 149 stakeholder attendees have to say about Patient Centered Care, and I forget what ideas are mine and what are somebody else’s, I am going to write this blog entry.

There was a day when becoming a healthcare worker was considered a calling. That calling was rated right up there with becoming a nun or a priest. It was kind of a sacrifice, a career chosen to be in service of society and sick people. There have always been different levels of caring. Some cared more than others, and some were just plain mean spirited..(nasty tempered crotchety nurses and doctors were not unheard of for sure). But, generally, becoming a medical worker meant your patients came first, and you genuinely cared. You didn’t just care because you were paid to. When you cared for patients, you didn’t consider what kind of insurance they had, or if they had any at all. You didn’t worry about who they were or where they came from. You never judged them. You just knew they were sick or injured and vulnerable and they needed your comforting and help. You gave that help/care unconditionally. I’ll admit, that was difficult sometimes, like the time I had to triage an arrogant young murderer and rapist of a little girl , or when I had to care for the young woman who beat my son black and blue when he was only 3 years old, while she baby sat him. But, I was never cruel to anyone, even those despicable people.
I didn’t recognize it during my years working as a nurse, but I believe I was delivering patient centered care. Of course, I never asked them how I was doing, so it might be a little arrogant of me to say that.

Now we have corporate centered money making care, government centered care, rich vs poor centered care, political centered care, and provider centered care.

The quality of care that a person gets now depends on way too many factors. Money is #1. If you do not have good insurance coverage, you will find it terribly difficult to find a practice that will care for you. Some say…that’s no problem…just go to the ER. The ER does not give patient centered care. They treat a problem, not the entire person. Healthcare maintenance and necessary screenings are not provided in ERs. If you cut yourself they will sew you up, but you will not get your hypertension or other chronic illness treated there. They only treat the immediate problem.

If you do have good insurance, there may be some who will take advantage of that and order studies that are not necessary. Automatically doing an MRI for back pain is not patient centered care…that would be money oriented care. MRIs are very expensive. Advil, heat alternated with ice and some gentle exercise may cure your back pain and at a much lower cost, to both you and your insurer.

Balance is necessary for care to qualify as patient centered.
This is a list of components that I think are absolutely necessary to qualify care as Patient Centered.

1. The patient is at the hub of their care
2. The patient is revered, respected and deferred to on all decisions
3. The patient makes the final decision on care
4. Questions are encouraged and answered.
5. All alternatives, including no care at all, are discussed and the advantages and disadvantages of all.
6. Possible complications, including possible harm and or infections must be part of the discussion of alternatives. Real time patient safety and quality data will be readily available on hospitals and other healthcare settings, and on providers.
7. No one will be asked to sign an “informed consent” until they are informed.
8. All projected costs would be laid out for the patient.
9. The patient’s age, healthcare status,  medical literacy, cognitive skills, abilities and disabilities, cultural beliefs, and all other particulars about the patient will be considered in recommendations and decisions about their healthcare.
10. Decisions on end of life or comfort care will be the decision of the patient as long as they are competent to make that decision. All patients will be encouraged to assign a durable Power of Attorney, and write a living will.
11. All possible preventative education will be provided to patients prior to treatment and/or hospitalization when time allows or during Hospitalization during emergencies
12. Appropriate screenings will be done according to age, and the care or procedures that patients are facing. Unless emergent, procedures will be delayed if screenings indicate that the patient is currently at risk if they have elective procedures.
13. A trusted bedside advocate will be with the patient if they want, at any time of day. Restricted visiting hours would be eliminated.
14. RN to patient ratios would always be appropriate for the level of care being delivered.
15. Long waits in waiting rooms and for assistance when hospitalized would be eliminated.
16. If things go wrong, honest immediate disclosure would take place and assistance (emotional/financial/other) in dealing with any harm would ensue. Patients would never be charged for costs associated with preventable healthcare harm. Patients and their families would become integral in the root cause analysis, and considered part of the solution so other patients would not suffer through a similar preventable harmful event.
17. Second opinions would be encouraged and a matter of routine. All insurances would reimburse for second opinions.
18. Patients will be able to request their records or at least a look at their records and there will be no reluctance or altering of records by the provider. Better yet, the patient can access their entire health record online.
19. Patients would not be expected to leave their free will at the door of a Hospital or other healthcare setting.
20. Patients would be cared for in freshly disinfected room with clean equipment, and never in a room with another patient. This eliminates chances of contracting an infection from a roommate or being mistaken for the roommate, and will be more conducive to having an advocate with the patient. All healthcare workers would wash hands with soap and water before and after any patient contact and it would be done without reminders from Patients or families.
21. Verification of patient identity and staff identity would be routine, particularly prior to procedures and medication administration. Evidence based bundles and check lists would always be used , observed, and mandated.
22. Only recipients of care get to declare if the care was Patient Centered.

This is a long list, I know, and it is probably incomplete. I can add to it anytime. I welcome additions!

  1. October 23rd, 2012 at 09:03 | #1

    Well stated Kathy. We are working toward a complete shift of power, control, & convenience.
    Transparency of cost, quality and outcome data will continue to instigate and empower this shift.

    My hope is that compassion and ethics will carry greater weight than profit and volume in our new system of patient-centered care.

    Thank you for all you do to be a voice for patients.

  2. October 27th, 2012 at 21:17 | #2

    Beautiful thoughts. Thank you.
    And thank you for your invitation to add to your list.

    With the many and varied interpretations of Patient/Person Centered I took a stab at what it meant to me.

    1. Help me achieve my short and long-term goals.
    • Make my needs and concerns a priority.
    • Communicate clearly and use plain language.

    2. Treat me with understanding.
    • Recognize I am being asked to learn about my condition without the benefit of medical training. Acknowledge the accomplishment this represents.
    • Ask me how much I want to be involved in my treatment plan.
    • Be sure we agree on what the next steps are for me and for the health care team.
    • Know that I may need help understanding Informed Consent, Advance Directives (Living Will) and Power of Attorney

    3. Consider my learning needs.
    • Understand that this is a learning process for me; make sure I’m ready to hear you.
    • When I’m ready, ask me how much I want to know: the minimum, on an as-needed-basis, or much as possible.
    • Give me time to absorb what you’ve said.
    • Ask what my learning preferences are (print, video, internet or all three) and give me suggestions for reliable, credible, evidence-based information sources.

    4. Know that I am part of a community.
    • Encourage me to share with my community, and address their questions and concerns in a follow-up appointment
    • Help me understand what’s needed to achieve my goals and to help me manage my expectations.

    5. Recognize that the final say is mine.
    • Respect my decision, even if it’s not what you would do or would recommend.
    • Support my decision, or help me find someone who can


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