The Patient as a Person
Let’s look more closely at our three concepts of patient-centered care:
- The Patient as a Person
- Building Relationships
The Patient as a Person
People who come into our clinic for treatment have long life histories. Their personalities will affect how they try to manage their kidney disease. If all you see when someone comes in for a treatment is a “patient” and you don’t take into account the other parts of their lives that are of value to them, you’ll have a hard time building a strong relationship.
The people who we give care to have families. They have jobs. They have communities they are active in. They have hobbies that they love. And, they have hopes and dreams just like you do. Patient-centered care asks that you learn their needs and goals and provide high-quality care that helps them reach those goals. Each person is unique and needs care tailored to him or her.
2. Collaboration – “The act of working together”
As you work with your patients, collaborate—don’t dictate. Managing a chronic illness like kidney disease is complex. Often, several care providers are needed to help: both formal ones like doctors, and informal ones like spouses, friends, and children. Patients have to learn to balance diet, fluids, meds, lab test results, and treatments. It’s not easy, and being treated like a child does not help.
The U.S. “Medical Model” of healthcare was set up for short-term, acute illnesses and accidents—not chronic disease. The “job” of someone with an acute health problem, like a broken leg, is to seek good care and comply with the treatment. There is no place for education or collaboration. In time, the leg heals and the person takes back his or her life.
Chronic disease does not go away, and the “Medical Model” doesn’t fit. A different “Chronic Care Model” is needed. In the “Chronic Care Model”, the goal is informed, active patients who take part in their care. Their job is not to comply! It’s to learn what they need to know to take an active role and self-manage their care. Self-management is a much bigger task than just compliance. It includes patients keeping themselves safe (e.g., noticing when someone has not washed his hands and speaking up), making good choices, and following their care plans. Your job is to collaborate and help them become good self-managers.
3. Building Relationships
We all want to have pleasant times with our patients. Beyond that, does the nature and quality of relationships with our patients really matter? The answer is yes. A large body of medical research finds that patients who trust their care providers—and believe that they want to help—have better health outcomes. They are more likely to take their meds the right way, too.
Here is what one leading expert has to say:
“A patient- and family-centered healthcare system would be radically and uncomfortably different from most today. Let me suggest a few examples.
“(1) Hospitals would have no restrictions on visiting—no restrictions of place or time or person, except restrictions chosen by and under the control of each individual patient. (2) Patients would determine what food they eat and what clothes they wear in hospitals (to the extent that health status allows). (3) Patients and family members would participate in rounds. (4) Patients and families would participate in the design of healthcare processes and services. (5) Medical records would belong to patients. Clinicians, rather than patients, would need to have permission to gain access to them. (6) Shared decision-making technologies would be used universally. (7) Operating room schedules would conform to ideal queuing theory designs aimed at minimizing waiting time, rather than to the convenience of clinicians. (8) Patients physically capable of self-care would, in all situations, have the option to do it.”
Donald Berwick, MD
Sound radical? Would it still sound that way if YOU were the patient? Chances are, all of us will be patients at some point, and we all want to be treated with respect, as if our needs matter. Your patients want that, too.
If your patients see that their relationship with you is built on trust, compassion, and honesty, they are more likely to feel as if you are on the same team. And, when you share trust, your patients are much more likely to talk about their needs—which will help you to meet them. Taking the time to build a strong relationship with your patients will pay off over time.
Now that you have learned that Rosa feels as if she isn’t part of the team let’s look at how you might apply patient-centered care.
You: “So you don’t feel like we include you in the choices and plans that are being made about your treatment. Can you share what you mean?”
Rosa: “Sure. Last week when you switched my treatment time by 30 minutes, no one even asked if it mattered to me. I am trying to go back to school, and that 30 minutes means I have to leave my class early.”
You: “You’ve gone back to school? That’s great! Why didn’t you tell us?”
Rosa: “Because you seem so busy and I didn’t think anyone cared. Then when you switched my time I just knew you didn’t care.”
You: “We do care. Let’s talk to the administrator about getting your time switched so you don’t have to leave class early. Are there any other issues or concerns you have about the approach we are taking with you?”
Rosa: “You just said: “the approach we are taking with you.” It’s like I’m just this passive person who has no say in my treatment. Last week, Dr. Kennedy came in and made my run time 10 minutes longer. I get that it might be good for me, but don’t you think she could have at least told me why she was doing this? In order for me to be part of the team, it seems important for me to understand and be part of the decision-making process.”
You: “I’m sure Dr. Kennedy just wants you to have the best treatment.”
Rosa: “I get that, but I should be part of that decision. I want to know why I need to run longer, and what it is going to do for me.”
You: “I guess I hadn’t thought about it that way. What might have been a better way to extend your run time?”
Rosa: “Just tell me what you’re doing and why. I trust Dr. Kennedy, but I need to have the choice explained to me. How would you feel if I just changed the time you end work to be later and never told you why I was doing it?”
You: “Is there more?”
Rosa: “Yes, I have been talking to some other patients, and what is this talk I hear about being able to do dialysis at home? I thought my only choice was in-center here. I have good support at home and I think I might really do well getting my dialysis at home.”
You: “Yes, there are other choices for dialysis. I know there is home hemodialysis, peritoneal dialysis, and even dialysis at night. I am going to call Dr. Kennedy and tell her that you need to get some information on the different types of dialysis.”
Rosa: “With my schedule it would really help me out to do my dialysis at home and have some flexibility. Plus, the patients were saying that the people they know who have been dialyzing at home feel a lot better.”
You: “I’m glad you told me about these issues, or I would just assume that all’s well. Now that we know this, we can try and make some changes in how we work with you.”
Rosa: “I appreciate that. All I want is to be part of this team.”