Patient-Centered Clinical Methods

• The traditional model of the doctor–patient relationship is being challenged, i.e., the traditional clinical (medical) model.
• This relationship is one-sided and focuses primarily on the disease or condition being treated.
• In the last decades, this paternalistic model has been criticized by health care professionals and patients alike.
• Health care professionals believe this traditional model lacks efficacy as patients do not necessarily follow doctor’s orders, especially when it comes to the prevention and treatment of chronic diseases.
• Patient-Centered Clinical Methods have recently been developed, partly as a response to the criticisms of paternalism in medicine.
• About 25-50% of patients visiting primary care practices don’t have a disease-specific diagnosis. Only through an understanding of the patient and the patient-doctor relationship can the physician gain insight into the problem.
• For successful therapy, you need to make the right diagnosis as well as understand the right context of the disease.
• Disease is the pathological disturbance of the body, while illness is the patient’s experience of the disturbance in terms of his feelings and fears, ideas of the condition, effect on his functionality, as well as his expectations.

Patient-Centered Care (PCC)

• Patient-centered care is the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient.
• It includes listening to, informing, and involving patients in their care.
• The Institute of Medicine defines PCC as:
• “Providing care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”
• Patient-centered care puts the patient first, prioritizing their needs over cost-cutting by managed care, doctor's egos, or financial gain.
• Patient-centered practice evaluates the individual patient’s clinical state, predicament, and preferences, applying the most efficacious interventions to maximize the quality and quantity of life for that person.
• “Patient-centered” clinical care contrasts with “doctor-centered” and ‘’disease-centered’’ clinical care.

Patient-centered care entails-

• Respect for patients’ values, preferences, and expressed needs;
• Coordination and integration of care;
• Information, communication, and education;
• Physical comfort; emotional support;
• Involvement of family and friends.

Patient- centered care

• Explores the patient's main reason for the visit, concerns, and need for information;
• Seeks an integrated understanding of the patient's world, including their whole person, emotional needs, and life issues;
• Finds common ground on what the problem is and mutually agrees on management;
• Enhances prevention and health promotion;
• Enhances the continuing relationship between the patient and the health provider.

The Differences

Medical Model	Patient-Centered Model
Patient's role is passive (Patient is quiet)	Patient's role is active (Patient asks questions)
Patient is the recipient of treatment	Patient is a partner in the treatment plan (Patient asks about options)
Physician dominates the conversation (Does not offer options)	Physician collaborates with the patient (Offers options; discusses pros & cons)
Care is disease-centered (Disease is the focus of daily activities)	Care is quality-of-life centered (The patient focuses on family & other activities)
Physician does most of the talking	Physician listens more & talks less
Patient may or may not adhere to treatment plan	Patient is more likely to adhere to treatment plan (Treatment accommodates patient's cultures & values)

Why Patient-Centered Care?

From research, the patient-centered method:

• Enhances patient satisfaction;
• Improves patient outcomes;
• Has a positive impact on healthcare utilization costs;
• Is associated with positive benefits for health professionals, such as greater job satisfaction;
• Is associated with fewer malpractice claims.

Key Principles of Patient-Centered Care

1. Respect for Patients’ Values, Preferences, and Expressed Needs
2. Coordination and Integration of Care
3. Information and Education
4. Physical Comfort
5. Emotional Support and Alleviation of Fear and Anxiety
6. Involvement of Family and Friends
7. Continuity and Transition
8. Access to Care

1. Respect for Patients’ Values, Preferences, and Expressed Needs

• Involve patients in decision-making, recognizing they are individuals with their own unique values and preferences.
• Treat patients with dignity, respect, and sensitivity to their cultural values and autonomy.

2. Coordination and Integration of Care

In the face of illness, patients often feel vulnerable and powerless. Proper coordination of care can alleviate these feelings. Three areas where care coordination can reduce these feelings are:

• Coordination and integration of clinical care;
• Coordination and integration of ancillary and support services;
• Coordination and integration of front-line patient care.

3. Information and Education

Patients often express the fear that information is being withheld from them and that they are not being completely informed about their condition or prognosis. To counter this fear, hospitals can focus on three kinds of communication:

• Information on clinical status, progress, and prognosis;
• Information on processes of care;
• Information to facilitate autonomy, self-care, and health promotion.

4. Physical Comfort

The level of physical comfort has a tremendous impact on a patient’s experience. From the patient’s perspective, physical care that comforts, especially during acute illness, is one of the most elemental services that caregivers can provide.

Three areas particularly important to patients are:

• Pain management;
• Assistance with activities and daily living needs;
• Hospital surroundings and environment:
  • Patient's needs for privacy;
  • Patient areas kept clean and comfortable;
  • Appropriate accessibility for visits by family and friends.

5. Emotional Support and Alleviation of Fear and Anxiety

Fear and anxiety associated with illness can be as debilitating as the physical effects. Caregivers should pay particular attention to:

• Anxiety over physical status, treatment, and prognosis;
• Anxiety over the impact of the illness on themselves and family;
• Anxiety over the financial impact of illness.

6. Involvement of Family and Friends

This principle addresses the role of family and friends in the patient experience. Family dimensions of patient-centered care were identified as follows:

• Providing accommodations for family and friends;
• Involving family and close friends in decision-making;
• Supporting family members as caregivers;
• Recognizing the needs of family and friends.

7. Continuity and Transition

Patients often express concern about their ability to care for themselves after discharge. Meeting patient needs in this area requires:

• Understandable, detailed information regarding medications, physical limitations, dietary needs, etc.
• Coordinate and plan ongoing treatment and services after discharge.
• Provide information regarding access to clinical, social, physical, and financial support on a continuing basis.

8. Access to Care

Patients need to know that they can access care when it is needed. Attention must also be given to time spent waiting for admission or time between admission and allocation to a bed in a ward. Focusing mainly on ambulatory care, the following areas were of importance to the patient:

• Access to the location of hospitals, clinics, and physician offices;
• Availability of transportation;
• Ease of scheduling appointments;
• Availability of appointments when needed;
• Accessibility to specialists or specialty services when a referral is made;
• Clear instructions provided on when and how to get referrals.

Six Interactive Components of Patient-Centered Care Model (PCCM)

1. Exploring both the disease and illness experience
2. Understanding the whole person
3. Finding common ground
4. Incorporating prevention and health promotion
5. Enhancing the patient-health care practitioner relationship
6. Being realistic

1. Exploring Both the Disease and the Illness Experience

The two models of ill health are assessed: the disease and illness dimensions.

• The disease process is assessed through history-taking, physical examinations, and laboratory investigations.
• The illness dimension is assessed by exploring the patient’s perspective of being ill, including subjective feelings, fears, ideas, effects on function, and expectations (FIFE).

FIFE, or ICE

• Illness explored in Patient-Centered History:
• Patient’s feelings about what is happening
• Ideas - what is causing the illness
• Concerns - what is worrying about the condition - Real reason for the visit
• Effects of the condition on function
• Expectations - What the patient hopes to get out of the visit

2. Understanding the Whole Person:

Be aware of the person as an individual by considering:

• The patient’s stage in the life cycle and the developmental issues;
• His proximal context like family, employment, social support;
• The distal context like religious and cultural beliefs and attitudes, community, ecosystem, etc., that can influence care.

No disease is ever just biological. It always has an effect on the person and the environment around that person.

These individual and contextual issues may impact significantly on their willingness to adhere to your management plan.

Recognizing, acknowledging, and eliciting when necessary, the person’s ideas, beliefs, concerns, and expectations is important.

Be aware of the typical challenges faced by someone at their developmental stage or part of the life cycle.

3. Finding Common Ground:

This entails the doctor and patient agreeing on:

• Mutual definition of the problems and priorities;
• Mutual definition of the goals of management; and
• Mutual exploration of the roles of the patient and healthcare practitioner.

4. Incorporating Prevention and Health Promotion:

• Use every opportunity for disease prevention and health promotion;
• Health enhancement;
• Risk avoidance;
• Risk reduction;
• Early identification; and
• Complication reduction.

5. Enhancing the Patient-Health Care Practitioner Relationship

Each encounter should be used to foster a therapeutic doctor-patient relationship by emphasizing:

• Compassion;
• Sharing power and control;
• Healing; and
• Self-awareness.

6. Being Realistic

Doctors have to be realistic in terms of:

• Time;
• Availability of resources;
• Extent of emotional and physical energy involvement;
• Team building and teamwork, which is allowed to reduce physician stress and burnout.