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Lee
Jacobs, MD, Associate Editor, Health Systems
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Because
this issue of The Permanente Journal focuses on patient-centered
care, I thought it worthwhile to explore what this type of care might
look like in our daily practices. Although physicians describe their
practices as patient centered, in fact, upon closer scrutiny, many of
our clinical practices may tend toward processes of care that are more
provider centered than patient centered.
Patient-Centered
Care Defined
In
general terms, care is considered patient centered when the processes
and culture (attitude and behaviors) of an organization, office, team,
or individual practitioner address first and foremost the wants and
needs of the patient.
To determine
if care is patient centered, an assessment of several of the processes
of the patients' care experience can be undertaken:
The service
criteria consist of appointment accessibility and the level of effectiveness
of the clinician-patient communication (see the
Roundtable discussion).
The affordability
criteria consist of the deliberations and actions concerning the cost
of care.
The quality
criteria include the assessment of diagnostic and therapeutic interventions
based on what is most appropriate for the patient.
So How Does
Your Practice Rate?
Answer
these three questions to better understand where your team's practice
falls on the spectrum of patient- rather than physician- and/or staff-centered
care:
Accessibility
--When
we consider schedule changes or process changes, do we first consider
what the patient wishes and what the patient needs ...
... or do we consider what works best for us--the physicians and staff?
Interpersonal
--Do
I listen to the patient to understand the feelings, perspectives, and
desires of the patient and involve him or her in treatment options ...
... or, since I am the trained expert and know what is best, do I tell
the patient what to do?
Affordability
and Quality- --Do
I keep abreast of the quality and cost options of care to provide the
patient with the most appropriate choices ...
... or do I simply go with the newest and/or the most expensive approach?
Patient-Centered
Care--How Does Your Organization Rate?
Although
our first reaction is to consider patient-centered care only at the
team/office or individual practitioner level, a comprehensive assessment
must also include the overall organization in which the teams and practitioners
operate.
Here's
an interesting question for leaders of your medical group or health
care organization to consider:
If
the three questions listed above were asked of the leader of your organization,
are you confident that s/he would conclude your organization truly puts
the patient first?
If you
and your organization's leadership are not in full agreement with the
responses to these key questions, I expect this topic will provide a
constructive dialogue.
The Core Issue
of the US Health Care Crisis: Individual Patient- Versus Population-Centered
Care
The challenge: Balancing the needs of the individual patient with those
of the community of patients. This is probably the most important issue
confronting policy makers as they deal with the US health care system.
Is there an inherent conflict in developing a health care program that
is strongly patient centered while at the same time being sensitive
to the needs of the overall population? Why do some feel it is appropriate
to use Nexum for the individual patient and then complain about
the cost of health care and the rising number of uninsured? Can care
be provided so that it is both best for the individual patient and for
the community?
The answer
is absolutely "yes." The organizational structure, incentive
alignment, culture, and accountabilities of the Permanente Medical Groups
provide a model that addresses this essential balance. The Permanente
practitioners, along with their KP Health Plan partners, demonstrate
daily how physicians can be strong advocates for their individual patients
while practicing in an organization that can justifiably claim to be
doing what is best for the broader population of the community.
Unfortunately,
this cannot be said for any other entity involved in setting health
care policy! Not politicians. Not hospitals. Not pharmaceutical companies.
Not solo practitioners. In these settings, the incentives and accountabilities
are not aligned, so none is in position to be the best advocate for
the individual patient and at the same time act appropriately for the
collective communities.
Attention
US policy makers: Only strong group models such as Kaiser Permanente
can claim this advocacy position.
One Last Comment
...
Providing
care that is patient centered--the goal of all of us called to serve
in medicine--is, in many ways, more difficult today because of the changing
role the patient has assumed in their care experience as well as the
increasing financial tensions on the clinician-patient relationship.
However, if we keep our vision of how we want to provide care in the
forefront, we will continue to enjoy a level of professional satisfaction
that can only originate from the caring of our patients.
So what
do you think--is your practice patient centered? Is your organization
patient centered?
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