In looking through the literature on person-centered care, the medical community’s weak response to it might signal that person-centered care is not really important, but rather something that falls into the category of nice things people do—like saying please and wearing deodorant. This is exactly the wrong attitude. Person-centered care is essential to achieving medicine’s most important goals; dismissing it as a mere nicety ensures that we stay stuck in a healthcare system that frequently places the needs of the system and its keepers over the health of the individuals seeking care in that system.
Medicine’s Quadruple Aim (1,2) is a widely endorsed framework for improving our healthcare system and includes: 1) Enhancing the patient experience; 2) Improving population health; 3) Reducing cost; and 4) Supporting healthcare providers. Person-centered care provides clear benefits for each of these pillars.
It is not surprising that treating patients as people would enhance their satisfaction with the services they receive and their healthcare providers.3 What is remarkable is that person- and patient-centered approaches to healthcare also reduce the cost of care largely through the elimination of unneeded and unwanted tests and treatments; they increase the morale of healthcare providers, and decreases burnout and malpractice claims; and, most importantly, they improve a wide range of health outcomes ranging from patient quality of life, to pain control, to objective outcomes such as blood pressure and survival times with cancer.(3-8)
There are numerous reasons why person-centered healthcare approaches are better than the alternatives of disease-centered, doctor-centered, or administrator-centered care. First, when patients are fully heard, they are more likely to guide doctors to the right diagnosis and therapies, and are more likely to accept and follow the therapies recommended to them. Second, this data explodes the lie that people will over-indulge in healthcare if it is provided freely. Perverse incentives of reimbursement and fear of malpractice claims are more often responsible for overspending. Finally, healthcare providers are more engaged in care when they are encouraged to see and build relationships with the person in front of them.
If you are not yet convinced, one could argue that healthcare providers have a moral responsibility to provide person-centered care based on the consequences of person-centered care (e.g. improved outcomes), ethical norms (e.g. respect for persons), and virtue-based theories (e.g. the influence of patient-centered care on provider behaviors and attitudes).(9)
Before I began researching this blog, I thought that perhaps person-centered care had yet to catch on because it was relatively new or lacked mainstream support. Neither of these assumptions is true. We’ve had compelling evidence for the benefits of person-centered care for over 35 years, (10) and the Institute of Medicine includes patient-centered care as one of its 6 quality aims. (11) So what is holding us back? We’ll explore this in our next and final blog in this series.
References:
1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576.
2. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769.
3. Wolf DM, Lehman L, Quinlin R, Zullo T, Hoffman L. Effect of patient-centered care on patient satisfaction and quality of care. J Nurs Care Qual. 2008;23(4):316-321.
4. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796-804.
5. Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res. 2019;19(1):13.
6. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
7. Stewart M, Brown JB, Boon H, Galajda J, Meredith L, Sangster M. Evidence on patient-doctor communication. Cancer Prev Control. 1999;3(1):25-30.
8. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.
9. Duggan PS, Geller G, Cooper LA, Beach MC. The moral nature of patient-centeredness: is it “just the right thing to do”? Patient Educ Couns. 2006;62(2):271-276.
10. Greenfield S, Kaplan S, Ware JE, Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102(4):520-528.
11. In: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC)2001.