There is an adoption problem with the concept of person-centred care (PCC). The precepts of this concept were detailed almost 30 years ago, and it has been vigorously promoted ever since. And while a commitment to PCC can be found on every Canadian health system website, it’s struggling to gain traction in what continues to be a discouragingly provider-driven healthcare system.
What’s afoot? Why the crazy slow adoption of PCC?
There are several reasons for this. If we examine the guidelines of PCC as first articulated, they appear somewhat provider oriented. Furthermore, as a current ICN member once wrote, the name PCC itself may be off-putting. Patients don’t necessarily want to be at the centre of their healthcare – sitting in an imaginary chair in the centre of an imaginary room being gazed upon by a coterie of health care providers. What most patients seek, whether they have verbalized it or not, is to be a part of that healthcare provider group, an equal member of the team, and one with insights no-one else can provide.
How best, then, to accelerate the adoption of PCC? Achieving this will require more than the implementation of principles. Implementation is of course necessary but not sufficient on its own. It will also require genuine patient engagement.
What comes to mind when you think about PCC? For most, thoughts will turn to lived experiences with healthcare providers or systems where PCC was clearly absent. Pick your example. Each of us will have our favourites. This author’s are notices such as: “Prescription renewals require an office visit,” or “Only one health issue to be addressed per office visit.”
In contrast to the above, patient engagement is best recognized when it’s present. Think about this. Visualize accompanying a family member to an appointment with their doctor and listening to them politely insist that they need much more information than they currently have about their illness or disease, its natural history, and the treatment options that may or may not be available for it. Then imagine hearing your relative gently point out that, once they have that information, they will expect to be an equal partner in any decision-making related to their medical care as opposed to being given a set of directions that they’re expected to follow. It’s true that patient engagement is best recognized when it’s present, and it is a basic requirement if true PCC is to be achieved.
Unfortunately, the skills required for each of us to become fully engaged patients are unlikely to develop spontaneously. We haven’t been trained by our health systems and their providers to behave that way. What to do? What skills must be acquired? How can this be accomplished?
In his next article the topic of patient engagement will be further explored by Dr. Bear. Stay tuned!
About the Author: Robert Bear is an ICN volunteer and Board member. He was previously a Professor of Medicine at the Universities of Toronto and Alberta, and is author of the medical novel “Sorrow’s Reward”.