The ever insightful and occasionally contrarian Don Berwick of the famous Insitute of Healthcare Improvement takes up the topic in a Health Affairs 'web exclusive.' It's worth a look for anyone interested in treading on the less traveled paths of health reform. While there is a surprising amount of policy history behind the idea, patient centeredness ultimately means that the patient is in charge. Period. That means it's the responsibility of the health care system to meet the patient's needs as defined by the patient - not the professionals, not HIPAA weenies, not pencil headed administrators and certainly not picayune insurers hiding behind reductionist definitions of medical necessity.
1) Patients may override evidence-based medicine. Dr. Berwick thinks that is a small price pay in exchange for responding to a population of patients that are far better informed than we give them credit for. It is very possible to rely on education coupled with lots of provider dialogue to help patients choose wisely. While some may make unwise decisions, that’s more likely a function of the quality of the education and the dialogue. Last but not least, a few crazy and demanding patients should not hold the rest of the medical world hostage.
2) Patients may use up precious resources. Dr. Berwick asks 'as defined by who,' especially when you consider that demand for health care services doesn't drive supply, rather it's vice versa. Paradoxically, if persons were truly allowed to make their own decisions, the overall demand for health care services could go down.
3) Patients may lose out on the two-way doctor-patient relationship. Dr. Berwick points out that it is far more common for docs’ to tell patients what they can’t have, coupled with emotional distancing. This is a way out of the ‘no, because…’ Desert to the Promised Land of 'yes, if....' Patient Centeredness is our way of getting over the Jordan River.
And he has some simple suggestions. For patients, care needs to be customized, transparent and fully under their control. The training of young physicians needs to be retooled. Older physicians need to be reassured. Finally, providers of health care services can measure performance on patient centeredness using long established and validated surveys created for that very purpose.
The DMCB is intrigued. While Dr. Berwick can be forgiven for restricting his perspective to the patient-physician axis, that doesn’t mean those of us in the population-based care business can’t go further in thinking about this outside the box: