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The revolution of patient-centred care

This weekend I was invited to speak on a panel with Dr. Peter Blake at the London Health Sciences Centre (LHSC) Patient and Family Advisor Orientation and Networking Event at Victoria Hospital. The event was part of a larger effort by LHSC to develop ways for current and past patients to provide feedback on the services provided by the hospital, and also to inspire a culture change within the organization to place patients at the centre of the care team–also known as the patient-centred model of care.

The old way of doing things

An older man in a wheelchair looking sad being pushed by a disaffected nurse
I’m not sure what they were going for in this picture, but whatever it was I think we can all agree they NAILED IT

The field of Disability Studies has long picked at the ways the medical establishment subjects and invalidates the voices and experiences of disabled individuals. The prevailing wisdom has been that doctors are the gatekeepers of sacred medical knowledge and it is their duty to deliver the ‘good news’ to any who will listen. But this exchange has long been a top-down hierarchical relationship, in which the doctors “do science” to the body, identifying patient deficiencies (from a clinically safe distance) and plotting a path for their recovery. There is very little room within the medical model of disability for the patient themselves to exist — they are not living, breathing people so much as broken objects to be put back together. The result of this philosophy is that the patients have little say in what “health” means to them and what outcomes they seek from their care. Instead, they must conform to the logic of medical science and capitalist definitions of health and well-being.

The patient-centred care revolution

The medical model philosophy has come under attack in recent years with responses, like the social model of disability, attempting to inject personhood back into this knowledge exchange. The work of disability advocates, along with the rise of target audience centred marketing orientations and capitalist adaptations to the meritocracy of the Internet, has birthed a new way of imagining health care spaces that place the patient at the centre of care. A problem brewing in privatized health care systems of the United States is that patients who are not satisfied with the service they received at a hospital are less likely to return to said hospital in the future, which has obvious economic consequences for the institution. The solution to this problem comes in the form of patient-centred care: an effort to begin listening to the patients to determine if the services being provided align within the expectations and desires of the consumer and make changes accordingly.

At its core, patient-centred care believes that it is the patient, not the doctor, who should be the prime mover of any medical intervention. Patient-centred care believes patients should be aware of all options available to them (and the consequences/side effects of those decisions) so they can make an informed choice about their care and take an active role in defining health care outcomes. This is not an attempt to devalue the specialized knowledge medical practitioners have but rather restructure the power relations (and imbalances) that currently exists between doctors and patients. Medicine should not be something done to people by doctors but something achieved through a collaboration of doctors and patients.

Patient-centred care as resistance

A protest banner that reads "Disabled people fight back! Nothing about us without us"
Photo from the Disability News Service

Of course, at its core, patient-centred care is a public relations effort, aimed at placating the masses and discovering how best to ensure repeat shoppers. But within these neoliberal efforts to develop loyal customers lay the seeds of resistance. As patient voices are given more authority within the system, we slowly are given an opportunity to change and mutate the systems to conform to our desires as opposed to being forced to live within preexisting boundaries. Patient-centred care really can lead to a democratizing of the healthcare experience and injects a personhood that has been sorely lacking for so long.

Although not perfect and still in its infancy, patient-centred care resists neoliberal encroachments into the healthcare field because it demands (and facilitates) an opening up of dialogue around health and well-being that is decidedly people centred rather than profit or efficiency centred. Patient-centred care acknowledges that people have a right to dictate the terms of their care and sometimes perhaps the ‘best’ thing for them is not the most logical. And that’s okay, because we should have the right to decide what happens to our bodies. Patient-centred care reduces the tyranny of the medical profession by placing the decision of ‘value’ within the hands of the patient/consumer themselves — we get to decide what is important for us and not have it forced upon us. Patient-centred care is the embodiment of the rallying cry for disability rights — nothing about us without us.

Finally, patient-centred care is also resistive to neoliberal encroachment because it demands a slowing down of the delivery of medicine. Rather than a conveyor belt of patients pushed rapidly through the system to maximize numbers and efficiencies, patient-centred care demands doctors take time to interact with their patients, explaining in lay terms what is happening and defining individual options. This shifts medicine delivery from a factory-style carousel of diagnosis and treatment options detached from the patient themselves into an actual interaction between people. Medicine is not something we should be striving to deliver faster because it takes time to do it right. Time to think, time to assess, time to allow emotion to wane and logic to prevail. In a medical world driven by patients, we are forced to move away from inhumane and impersonal healthcare exchanges toward individualized experiences between doctor and patient — two equally important pieces in the equation of ‘health.’