Letting patients have their say

Dr. Pauline Chen's column this week focuses on a conversation with health quality expert Dr. Donald M. Berwick. Dr. Berwick advocates a radical change in how health care is delivered in this country to a system that is truly patient-centered. As it stands now, the system is physician-centered; everything from how the hospital gowns to the set up of medical records is set for the convenience of the physician. But such physician-centered care creates passivity in patients, when numerous studies and experience show that active and engaged patients have better health outcomes.

But advocating a radical shift to patient-centered care and decision-making raises questions about the burden on the patients. Physicians train for years to learn evidence-based medicine and best practices. Is it fair or responsible to ask a patient with no medical training to weigh and make major decisions about their care, especially when they are sick?

It seems that the ultimate goal of patient-centered care is that the patient would have an active voice in the planning of their care. That is not to say that the patient does the physician's job, but that the patient and physician are able to openly communicate about the reasons for and against a course of treatment and both are able to come to and understand a decision for treatment. Effective and on-going communication and trust are fundamental to this process. If a patient doesn't understand the reason for a treatment or doesn't trust the physician's skills and intentions, then neither the patient nor the physician is going to get anywhere near quality of care and outcomes.