Patient-Centered Care? Well, It Depends

A funny thing happened when I wrote my last post for White Coats, Paper Gowns: I became inspired by some of the very advice that I was criticizing. After reading hundreds of tips designed to help patients become empowered, I took charge of my own health care.

I’d been seeing a doctor for tendinitis in my left foot. A month later, the pain and stiffness felt worse, and I’d started limping. On top of that, my podiatrist said he had nothing else to offer me after the drug that he’d prescribed made me ill.

I found another physician and sought a second opinion. The new doctor strapped a brace around my ankle and sent me to physical therapy. That quickly soothed my pain and eased my walking.

What Patients Want

Taking charge helped me heal, but I wince when health-care agencies tell patients to do so in order to receive better care (http://www.sharp.com/grossmont/take-charge-health-care.cfm http://healthfinder.gov/HealthTopics/Category/doctor-visits/talking-with-the-doctor/take-charge-of-your-health-care). They seem to be missing a key point of patient-centered care: the idea that patients should receive care that meets their needs and respects their preferences.

Most patients want a say in treatment decisions. They also want more useful information than their doctors provide. Even so, many people prefer not to take charge of their care.

For instance, roughly 16 percent of cancer patients show little desire to seek information about their illness. Typically, these patients rely on their doctors to tell them what they need to know; they trust medical experts to decide on their care. Far from passive, these patients believe in carrying out their doctors’ recommendations.

Patients with little desire to seek cancer information fall into two groups. The first group includes those who want minimize the effects of cancer on their daily lives. They would rather take care of their families or work at their jobs than read about radiation treatment. They want to stay in control of their lives, not let everything fall apart while they focus on their cancer.

Patients in the second group try to avoid information that might worry them. They prefer to keep their spirits up and their hope alive.

Both groups cope with a scary illness as they see fit. Their ways differ from my usual coping style and, like mine, might not suit every situation. Still, patient-centered care involves respecting patients and helping them reach their treatment goals, even when patients act differently than health-care professionals deem wise. When health agencies tell patients to “do” health care in a particular way or risk the consequences, it reminds me of the authoritarian ways of old, except that “The doctor knows best” has given way to “Take charge of your health care.”

Alas, much of the guidance on how to get good health care recognizes only one kind of patient. True patient-centered care respects patients as individuals. It comes in at least as many forms as they do.

Photo copyright yasemin/123rf.com stock photo

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