1.3 A Day in the Life: Patient-Centered Care
Anita Hedlund
As discussed previously, patient-centered care has not always been the norm. In the past, doctors were seen as the authorities in healthcare and patients were expected to do what they were told. NEJM Catalyst (2017) states that “Patient-centered care represents a shift in the traditional roles of patients and their families from one of passive ‘order taker’ to one of active ‘team member.’” Today, patients ask questions and have the ability to research conditions and medications on the internet. The expectation from both patients and healthcare workers is that healthcare will be tailored to the individual. Patient-centered care means the patient is the central decision-maker about their own healthcare, with support being provided by the various members of a healthcare team. Patients and their family or support network are invited to be full partners in planning care and understanding their health. Patient-centered care takes into consideration many factors, such as patient and family preferences, values, cultural traditions, language, and socioeconomic conditions.
The key to patient-centered care is to offer respectful and considerate care, whatever the patient chooses after being informed of their options. For example, patient-centered care takes into consideration any resources the patient may need, such as transportation to clinic or hospital visits, home healthcare, physical therapy, and dietary education. Patient-centered care also considers factors that affect the patient’s access to services, such as whether a patient lives in a rural or urban setting and the type of providers in their area. If the patient wishes to include a person from their faith or spiritual tradition in their care, this is welcomed and facilitated. The goal is that the “right care is provided at the right time and the right place” (NEJM Catalyst, 2017).
Consider Abeba’s story from the beginning of the chapter. Aster, Abeba’s mother, had to navigate the U.S. healthcare system when she began to show symptoms of diabetes. Abeba accompanied her mom to clinic visits. These visits were a challenge, as Aster was still learning English. While Abeba might have wanted to act as a translator, the clinic instead arranged for a medical interpreter. When complex medical discussions are taking place, it is best that family members are not acting as translators. Although family members may not lack the English skills to translate, without the proper training and knowledge of terminology, there is no way to ensure that information is being accurately conveyed. In Aster’s case, the clinic arranged for a medical interpreter to ensure medical information was accurately received and questions and confirmations from Aster were clearly communicated to the healthcare team.
Part of a patient-centered approach is ensuring appropriate care is given by the best healthcare professional for the task. For example, when Aster arrived for her appointment, a receptionist was there to check Aster in. Then, a medical assistant (MA) checked Aster’s weight and vital signs, such as temperature, pulse, blood pressure, oxygen level, and breathing rate. Next, the physician, Dr. Gomez, discussed Aster’s symptoms. Dr. Gomez said Aster needed lab work done, so the MA came back and collected some blood from Aster to send to the lab. Aster was instructed to return to the clinic the next week. After the lab work came back, Dr. Gomez determined that diabetes was the most likely cause of Aster’s symptoms. Working with Aster, Dr. Gomez recommended adjusting Aster’s diet, increasing Aster’s level of exercise, and taking medication to control blood sugar levels. The healthcare team then brought in a registered nurse (RN) who had special training in management of diabetes. The RN met with Aster and Abeba and explained how they could work together on the lifestyle changes Dr. Gomez recommended. Next, Aster was scheduled to meet with a registered dietician to discuss the food choices that Aster was advised to make, taking Aster’s cultural food preferences into consideration. Once Aster indicated understanding of all the new information and had a chance to ask questions, the healthcare team scheduled follow-up visits to track Aster’s progress. Abeba saw this process as Aster being at the center of a circle with different team members around her working together to ensure she had the information and support she needed. Aster’s experience inspired Abeba to pursue a healthcare career. She, like many of us, wanted to be a part of someone’s patient-centered journey.
Attributions
- Figure 1.10: Original Image by Katherine Kelley, SBCTC is released under CC BY 4.0