Tag Archives: patient-centered care

Patient-centered care in an iPatient world

iStock photo
iStock photo

Ever think about the origins of the barber pole with its red and white strips and brass cup?  It represents the bloody bandages of the barber profession from centuries ago which included performing surgeries and dentistry for customers.  You can guess what the cup was used for.

Present day doctoring has advanced in so many ways since the days of knives and bloodletting.  Now there is robotic surgery and nuclear medicine. The training and expertise needed by today’s physician attest to the skills required to operate complex instruments and the software that runs them.  

And while the advancement of these innovating technologies has been welcomed in the health care community, experts are questioning whether the patient has been left behind in the push towards modernized medical treatment.  Welcome to the world of the “iPatient”.

“The patient in the bed has become an icon,” according to Abraham Verghese, M.D., renowned physician, author, and senior associate chair for the theory and practice of medicine in the Department of Internal Medicine at the Stanford University School of Medicine.   He spoke at the Fifth Annual Medical-Spirituality Conference sponsored by Boonshoft School of Medicine, Wright State University.

Verghese suggests the purpose of admission to a hospital is to “render the live 3-demensional patient into a 2-demensional image.”  In other words the patient is viewed from screens, displays and readouts. This rise in “remote diagnosis” is to help speed the treatment process, especially when several specialists are involved.  That can often lead to stress and other issues that adversely impact healing, according to Verghese.

The work that goes on behind a monitor and in the conference room on behalf of the patient can actually promote a feeling of inattentiveness on the patient’s part.  A sense of isolation and lack of connectivity ensue, feelings that do not encourage healing.  “We are hungry for Love, for the white-winged charity that heals and saves,” wrote Mary Baker Eddy, a late 19th/early 20th century pioneer in the research linking consciousness and spirituality to well-being.

A 2-demensional patient is really a misnomer.  In fact a 3-dementional patient is also an inaccurate rendering of man and womanhood.   The intangibles of being, things like love, compassion, confidence, hope and other qualities point to the multi-dimensional facets of the individual, aspects that cannot be ignored in securing healthy outcomes and furthering long lives.

Verghese points to the intricacies of patient care when referring to something as simple as a doctor’s tone of voice. He remarked during the conference that his or her bedside manner and attitude can have a placebo (positive) or nocebo (negative) effect on the patient.

A vocal advocate for patients, Verghese says that the new buzzword in health care delivery is “patient satisfaction.” While striving for quality has been the focus of health professionals for some time, patient-centered care is getting a lot of attention.  Seeing the patient as an integral part of the healing process will help in the drive towards quality care.

Verghese quoted Dr. Francis Peabody, early 20th century internal medicine specialist responsible for establishing hospitals in the U.S. and China. He too was a strong supporter of the patient. “For the secret of the care of the patient is in caring for the patient.”  That’s the bedrock of health care. 

More Americans electing new strategies to health care

The results are in: Americans are voting to broaden their approach to healing and health maintenance.

While waiting for the outcomes of national and state elections have slowed some current health care reform efforts, patients and health professionals continue to talk about “patient-centered care” and endorse an expansion of practices beyond “conventional” medical models. These can include prayer and mind/body practices, the use of natural products, or massage and chiropractic services.

Why the shift? Experts point to several factors.  One is the challenges of the current health care system – some of which are inherent to the use of chemicals and surgery on the human body and some more due to a large system that is in overload and unduly influenced by dollars.  Another is the increased confidence inspired by the beneficial results being reported when using complementary and alternative methods. In other words patients are finding they work.

One of the biggest challenges with the current approach to health care might be equated to the old adage; too many cooks spoil the broth.  That’s certainly true. When too many people take charge, the results can be ruinous.  A modern day variant of the axiom might go: Too many doctors can be bad for your health. That’s the headline in a Consumer Reports article published recently.

Orly Avitzur, M.D., Consumers Reports Medical Adviser, points to an issue of the Archives of Internal Medicine confirming “what doctors have long known—that many patients are suffering from too much care.”

Avitzur goes on to cite a March 2012 report published in the Journal of the American Medical Association (JAMA) that lists four areas where overtreatment is leading to medical problems: over medication, too much testing, waste of time and resources, and increased stress resulting from too many opinions.  He concludes, “In fact, when it comes to your well-being, less is often more.”

Yet, beyond the concerns of over-diagnosis and over-treatment, patients are demanding the implementation of alternative disciplines as an avenue toward healing.  And health experts are responding.

42 percent of reporting hospitals offer at least one type of complementary medicine according to a survey conducted by the American Hospital Association and the Samueli Institute.   That’s up from 27 percent just five years earlier.

“Experts say hospitals are embracing these therapies for many reasons, including a growing recognition that some integrative therapies, as they’re also called, are very effective in some instances,” writes Michelle Andrews for Kaiser Health News.

Indeed, many respected hospitals across the country are committing more resources to this approach. The Centers for Integrative Medicine at The Cleveland Clinic and The Ohio State University have joined with 51 other institutions to form the Consortium of Academic Health Centers for Integrative Medicine whose mission is to advance the principles and practices of integrative healthcare within academic institutions.

Additionally, over the last few decades more than 1500 studies have been made on the role spirituality, prayer and religiosity have in health. And, summaries of these studies indicate consistently, prayer and/or meaningful ties to a religious practice or faith community improve health results.

I have always appreciated the thought-provoking Bible account of the man waiting by the pool a substantial amount of time in need of healing. Before his health is restored, Jesus asks him, “Do you want to get well?” To me that question points to a responsibility each of us needs to take in our own thought and actions as we commit to healthy outcomes.

These advancements in healthcare are evidence of a changing mindset of mandated medical intervention to a growing awareness of other effective practices contributing to health and healing, especially the importance of thought on health. As patients are given a bigger voice in their treatment plans and elect to make appropriate lifestyle choices, they are coming to the realization of how much freedom and independence they have in pursuing healthy lives. That is something we can all vote for.

 

This column was recently posted on Spot 55.com.