Patient Centerd Care

PATIENT-CENTERED CARE
Dr. Suha Hamshari

P.B.F.M
Faculty of Al Najah
HISTORY
 1950 – Michael Balint explored ‘illness-centered’
medicine, conventional method inadequate to reach
deep understanding of patient illness.
 1964 – Balint dev. Concepts of ‘attentive’ listening
and responding to patient offers.
 1970 – Ian R. Mc Whiney – patient-centered care
medical model
 1986 – Levenstein et al evaluated and formulated
patient centered as clinical method
The intuitive mind is a sacred gift, and the
rational mind is a faithful servant. We have
created a society in which we honor the servant
and have forgotten the gift.
Albert Einstein
Definition
Defined as ‘a philosophy of care that encourages:
(a) shared control of the consultation, decisions about

intervention or management of the health problems with
the patient, and/or
(b) a focus in the consultation on the patient as a whole who

has individual preferences situated within social context’ (in
contrast to a focus in the consultation on a body part or
disease)
c)“treating patients as partners, involving them in planning
their health care and encouraging them to take responsibility
for their own health”
d)help your patients become medical decision makers who

take an active role in their own care’
Cochrane review, issue 2, 2003 & Lowes R. 1998. Patient-centered care for
better patient adherence. Fam. Prac. Management
Video
• https://www.youtube.com/watch?v=pj-
AvTOdk2Q
THE SCIENCE OF PATIENT CENTERED CARE
It expands on the ‘disease-oriented’ model by incorporating

the patient’s experience of illness, the psychosocial context
& sharing decision making with patient and his family.
“The process of healing depends on knowing the

patient as a person, in addition to accurately
diagnosing their disease.”
Ronald M, J. Fam. Pract 2000, no 49

Aspects of patient centered care
 Respecting people’s values and putting people at the center of care

 Taking into account people’s preferences and expressed needs
 Coordinating and integrating care
 Working together to make sure there is good communication,
information and education
 Making sure people are physically comfortable and safe
 Emotional support
 Involving family and friends
 Making sure there is continuity between and within services
and making sure people have access to appropriate care when they
need it
Look for the patient …..
Level of patient- centered care
1.The experience level
individual patient’s experience of their care
2.The clinical micro-system level
service, department or program level of care.
3. The organizational level
the organization as a whole.
4. The environment level
the regulatory level of the health system.
The evidence for patient- centred care
 Studies show that when healthcare administrators,

providers, patients and families work in partnership,
the quality and safety of health care rises, costs
decrease, and provider and patient satisfaction
increase
Examples …..
 The Institute for Patient- and Family-Centered Care states that
patient- centred care has become the business model for the
Medical College of Georgia
 The following represents three years of quality improvement data:

 patient satisfaction increased from the 10th to 95th percentile
 volume of discharges increased by 15.5 per cent
 length of stay in neurosurgery decreased by 50 per cent
 medical error decreased by 62 per cent
 staff vacancy rate decreased from 7.5 per cent to 0 per cent
 perception of the unit by doctors and staff underwent a positive
change
PATIENT-CENTERED METHOD
Six interactive components:

1) Exploring both the disease and the illness experience.
2) Understanding the whole person.
3) Finding common ground regarding management.
4) Incorporating prevention and health promotion.
5) Enhancing the patient-doctor relationship.
6) Being realistic.
1)Exploring both the disease and the illness
experience
Assess the two model of ill health: disease and illness

• Dimension of disease
• Assess the disease process by history, examination
& the differential diagnosis
• The dimension of illness
– How patient feels about being ill, what the patient’s ideas about
the illness, what impact the illness has on the patient’s function,
what he or she expects from the physician
Disease-
 Theoretical construct terms of abnormality structure/

function of body organ/systems including physical &
mental disorder.
 It is diagnostic explains what a disease has in common

with others.
 Established by conventional method.

Illness-
 Patient personal experience of ill health.
 Unique in each patient.
 Need additional approach.
4 principles dimension of patient illness:

1) Their ideas of what is wrong with them
2) Their feelings especially fears about being ill
3) The impact of their problems on functioning
4) Their expectations of what should be done.
Requires skill in interviewing to enable doctor to ‘enter

into the patient’s world’
2)Understanding the whole person
 Integrate the concept of disease and illness with an

understanding of the whole person.
 Includes an awareness of the patient’s position in the life

cycle and the social context in which they live
The family and anyone else involved in or affected by

the patient’s illness; the physical environment
Cultural beliefs & attitudes also influences care
3)Finding common ground
 Mutual definition of the problems and priorities

 Mutual definition of the goals of management/
treatment
 Mutual exploring of the roles to be assumed by
the patient and the doctor in the management
Required areas doctor and patient to agree :
1)The nature of the problems and priorities.

E.g – tumor & migraine.
2)The goals of treatment- negotiate reasonably.

E.g- FBS in diabetic pt.
3)The roles of the doctor & the patient.

4)Incorporating prevention and health
promotion
“Use each visit as an opportunity for prevention and
health promotion”
Health enhancement
Risk reduction policies
Early detection of disease
Ameliorated the effects of disease
Health enhancement:
Doctor & patient monitor areas in patient’s live that
need improvement for long term physical & emotional
health.
Risk reduction & early detection :

 Doctor monitor, recognized problems and screen
unrecognized disease.
 Doctor collaborate with other health professionals
implementing health promotion & screening.
5)ENHANCING THE PATIENT-DOCTOR
RELATIONSHIP
• Characteristics of the therapeutic relationship
– Each encounter with patient should be used to develop the
doctor-patient relationship
– Caring and healing approach
– Transference and countertransference
• To develop trust and respect
– Sharing power
– Self awareness
• This has impact on other components of the method
 Doctor seeing same patient, with variety of problems,
acquire personal knowledge that may help in future.
 Every visit develope continuity of care and effective

long term relationship.
 Different patient needs different approaches.
i. e.g.– praise patient who follows their treatment plans

properly.
ii. supports those having difficulty in reaching goals.
iii. asking about their feelings and opinion shows that
their input is important.
6)Being realistic
Throughout the process, physician have to be realistic in
terms of time, availability of resources and the amount
of emotional and physical energy needed
Time: Manage time efficiently for maximum benefit of
patient.
Resources : Develops skills of priority setting, resource
allocation, teamwork.
Team building : Doctors also must respect their own
limits of emotional energy and not expect too much of
themselves.
Patient centered care is ….
1. Not a strictly defined process, sequential stages,
standardized procedures or interviewing styles
2. Though presented separately, reality – interwoven.
3. Varies from patient to patient.
4. Learning is different from acquiring the process.
5. When performing focally aware of the whole process,
not the components
Patient centered as high quality of health
care
Good- quality of care are defined as :
 Safe
 Effective
 Patient centered
 Timely
 Efficient
 Equitable
WHY PRACTICE PATIENT-
CENTERED CARE?
 Improved satisfaction for patient and service
provider.
Patient-centered approach have positive relationship with
patient recovery, emotional health, physical function and
physiologic outcome and treatment satisfaction.
 Improved adherence.
Research shows patients more likely to take their pills, lay off
sour cream, show up for appointment thus a better patient
adherence.
 Evidence that patient-centered

communication skills promote adherence.
 Functional outcome improvement.
Research shows fewer limitations imposed by the
disease on patient functional ability.
 Decreased litigation
Studies demonstrated that physicians behave like
devaluing patients views, delivering information poorly,
failing to be attentive to patients perspective often face
malpractice claims.
Common questions regarding patient-centered
care
1.Conflict between patient expectation and medical assessment?
Physician try to reconcile the two conflicting views.

E.g – refused admission when unnecessary,
pt. demand narcotic drugs.
2. Risk of invading privacy?

Allows and encourage expression without forcing.
3. Always necessary to use the method?

We don’t know unless we ask.
4. Time consuming?
average length of office visit plus physical examination is 21
min either conventional or patient centered.
Lots of time get waste in doctor-

centered visits because the Doctor
goes on and on about medical
information that doesn’t address
what’s on the patient mind.
In patient-centered visits, the
Doctor talk less and the patient says
more.”
THANK YOU

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PATIENT-CENTERED CARE

Dr. Suha Hamshari

(a) shared control of the consultation, decisions about

(b) a focus in the consultation on the patient as a whole who

d)help your patients become medical decision makers who

It expands on the ‘disease-oriented’ model by incorporating

“The process of healing depends on knowing the

Ronald M, J. Fam. Pract 2000, no 49

 Respecting people’s values and putting people at the center of care

 Studies show that when healthcare administrators,

 The following represents three years of quality improvement data:

Six interactive components:

Assess the two model of ill health: disease and illness

 Theoretical construct terms of abnormality structure/

 It is diagnostic explains what a disease has in common

 Established by conventional method.

4 principles dimension of patient illness:

Requires skill in interviewing to enable doctor to ‘enter

 Integrate the concept of disease and illness with an

 Includes an awareness of the patient’s position in the life

The family and anyone else involved in or affected by

 Mutual definition of the problems and priorities

1)The nature of the problems and priorities.

2)The goals of treatment- negotiate reasonably.

3)The roles of the doctor & the patient.

Risk reduction & early detection :

 Every visit develope continuity of care and effective

 Different patient needs different approaches.

i. e.g.– praise patient who follows their treatment plans

 Evidence that patient-centered

Physician try to reconcile the two conflicting views.

2. Risk of invading privacy?

3. Always necessary to use the method?

Lots of time get waste in doctor-

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