Recently I gave a presentation and asked the audience – hasn’t the care we have provided always been patient centered? Understand that there were a number of clinicians in the audience who, like me, have more than 30+ years of experience. Their answer was “absolutely” we have always provided patient-centered care.
But did we? As individual clinicians I totally concur with that audience. In all my years of practice, I have always done my best to provide care that was focused on the patient’s needs, wants, and preferences. However, there was a caveat – within the context of the times. Ok, I know you are asking what I mean by the context of times. For those clinicians who have only been practicing during the last 10 years – well, you are just going to have to believe me or go confirm what I am about to tell you with a colleague with more longevity.
When I started my nursing career in 1977, the healthcare world was a very different place. Being honest, it was a very physician-centric and patriarchal environment. Patients were expected to do what they were told. As a registered nurse working in an acute care facility, I was not allowed to tell the patient what medicines I was giving them, but instead had to tell them to take their questions to their physician the next time he came in but swallow these pills now please. While we did do patient education, it was not nearly as comprehensive as today – perhaps because patients stayed in the hospital until they were pretty much well not just less sick. Depending on the viewpoint of the physician, there were times we didn’t tell patients they had cancer because they couldn’t handle the information and it would make them worse. Or the full range of options was narrowed down prior to talking to the patient and family because they wouldn’t understand.
I wish I could say that these types of situations don’t occur anymore but they do. As an informatics nurse, I cringe when I read opinions that we can’t use self scheduling systems for ambulatory care because patients/caregivers aren’t capable of scheduling correctly. Or that provider notes should not be available because “they” might misunderstand what is written. Using the 80-20 rule, do we deny the 80% because the 20% might need more help?
Patient centered care is about partnerships with those who need us. It’s a relationship between people which is characterized by mutual cooperation and responsibility1 and I would add that there is respect between the individuals. It is not about one person having power over another. It is recognizing that one person may choose to take a different path or have ideas that are different from ours.
So my question to you – do you think patient centered care is a new concept?