What does it mean to be a patient who gets patient centered care? As discussed in our conversation about putting patients first, this wasn’t always the case. In the past, Doctors were seen as the authorities in healthcare and patients were expected to do what they were told. The New England Journal of Medicine stated 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” (NEJM, 2017). Now, patients ask questions, with 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 what is happening with their health. Many factors are taken into consideration like patient and family preferences, values, cultural traditions, language spoken, and socioeconomic conditions.

The key is to offer respectful and considerate care, whatever the patient chooses after being informed of their options. What resources does the patient have and what do they need? Examples include transportation to clinic or hospital visits, home health care, physical therapy, dietary education, etc. The patient’s access to care, for example if a patient lives in a rural or urban setting, and the type of providers in their area are also examined. If the patient wishes to include a person from their faith or spiritual tradition in their care, that is welcomed and facilitated. The goal is that the “right care is provided at the right time and the right place” (NEJM, 2017).

Let us review Abeba’s story from the beginning of the chapter. Aster, Abeba’s mother, had to navigate the US 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 gaining skills as an English language learner, creating a communication barrier. 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 aren’t acting as translators. It isn’t because of a lack of English language skills, but instead that without the proper training and knowledge of terminology, there isn’t a way to ensure information is accurately portrayed. So the clinic arranged for a medical interpreter, not only to ensure medical information was received, but questions and confirmation 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) would get Aster’s weight and vital signs, such as temperature, pulse, blood pressure, oxygen level, and breathing rate. Next, the physician, Dr. Gomez, came and discussed the symptoms Aster was having. Dr. Gomez said Aster needed lab work done, so the MA came back and collected some blood from a vein in Aster’s arm and filled some tubes to send off. 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 believed that treatment would include adjusting Aster’s diet, and to increase Aster’s level of exercise to lose weight, and start taking medication in order to control blood sugar levels and stay as healthy as possible. The healthcare team then brought in a Registered Nurse (RN) who had some 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 specific 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 it as Aster being at the center of a circle with different team members around her all working together to make sure 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

1. Figure 1.10: Original Image by Katherine Kelley, SBCTC is released under CC BY 4.0