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    Discerning the real meaning of patient-centered care

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    Sarah J. Kilpatrick, MD, PHD
    Patient-centered care is the buzzword for a new trend in healthcare. It sounds great, it sounds as if we should pursue it, it sounds politically correct. It sounds as if everyone would vote for it and it might be the fix that US healthcare needs. If only we could be patient centered, then our healthcare woes would be over.

    But what does patient-centered care mean? Hasn't the patient always been the focus of our attention? If we didn't have patients, we wouldn't have jobs, hospitals, clinics, drug companies, health insurance companies. So it is hard to argue that patients have not been at the center of US healthcare.

    Somehow in the last 20 years, other entities vying for attention, convenience, and resources have gained more control and possibly influenced healthcare for ulterior motives. Healthcare organizations have focused on the business of making money, potentially at the expense of patient experience and safety at times. Insurance companies likewise have as their first priority profit, not patient well-being. Pharmaceutical companies, in the name of saving and improving lives, have created huge corporations that market directly to the consumer wares that are purportedly better than generic drugs. Even physicians in the climate of increasingly higher debt after training and falling healthcare reimbursements have influenced practice strategies to be more convenient for them and less convenient for the patient.

    Today I conjecture that the direct physician-to-patient time, whether in the office or the hospital, is dramatically less than it was 20 years ago because we have been forced to become more efficient to make more money for everyone but the patient or to be less efficient to improve safety.

    Although these clearly are oversimplified generalizations, they illustrate that medicine no longer is just about what is best for the patient. One of the best examples of the new focus on efficiency is the electronic medical record (EMR). It is a tremendous asset over time: To be able to read the records, not lose the records, and to use automatic queries and safety checks are tremendous steps toward reducing redundancy and improving patient safety. However, the patient does not experience these advantages directly. In fact, the provider spends more time at the computer and less time with the patient. So, ask the patient: Is this better?

    There is no doubt that we need to step back and look at what has happened. We need to make the patient the primary focus again and remind ourselves that we are in medicine to make people better or to help them have better health, which means we need to know how best to do that.

    If that is what patient-centered care means, I am all for it. The admission to labor and delivery is about her: We are there to take care of her, listen to her, talk to her, explain to her and her family the management plan because we made the management plan using our knowledge, our best judgment, and our compilation of the facts, and we incorporated her input in the process.

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    Sarah J. Kilpatrick, MD, PhD
    Dr. Kilpatrick is the Helping Hand Endowed Chair in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los ...

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