Blog#5 Foundational Concepts: Patient-Centered vs -Informed

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The current state of healthcare in America, and indeed across developed nations, is clearly at an impasse. Despite the remarkable strides we've made in scientific discovery, one might wonder, are we genuinely any healthier?

Recent literature underscores the persistence of familiar challenges. Despite our groundbreaking advancements in medical technology and healthcare delivery systems, the specters of healthcare access, affordability, and equity still loom large (Davis et al., 2021). Non-communicable diseases, ranging from cardiovascular maladies to the complexities of cancer and mental health afflictions, continue to exert a considerable toll on healthcare infrastructures worldwide. And then came the grand reckoning of the COVID-19 pandemic, laying bare the vulnerabilities of our healthcare systems and emphasizing the critical importance of readiness and resilience in times of crisis (Kutzin et al., 2020).

In the face of these formidable challenges, there is a growing recognition for a shift from our conventional reactive system of care to a more proactive approach in healthcare delivery and public health initiatives (CDC, 2020; WHO, 2021). While the introduction of patient-centered care marked a significant stride away from the paternalistic practices of before, it still falls short of fully empowering patients to drive healthier decisions and steer the world towards better population health outcomes.

For those pondering the nuances between what patient-centered versus patient-informed care really is, allow me to extend a warm welcome to a topic close to my heart. 

The history of medicine, from the days of Hippocrates to the late 20th century, was largely characterized by paternalistic norms. Patients would present their maladies to their physicians, receiving remedies with minimal discourse or inquiry (an example of this is bloodletting). Yet, with the dawn of the information age and the rise of more inquisitive generations, this traditional approach gradually lost its luster. Patient-centered care emerged as a beacon of progress amidst this evolving landscape, permeating medical education with its principles of empathy, collaboration, and respect (Stewart et al., 2003).

Patient-centered care, at its core, aims to customize healthcare services to align with the unique needs, preferences, and values of each individual. This approach is particularly vital in discussions surrounding end-of-life care, where considerations of a patient's values dictate resuscitation preferences and the extent of medical intervention. Grounded in empathy, patient-centered care strives to grasp the patient's perspective, involve them in decision-making processes, and accommodate their cultural, social, and psychological intricacies. Undoubtedly, this paradigm shift has yielded commendable outcomes, from mitigating medical errors to enhancing treatment adherence.

Yet, amidst these triumphs, certain gaps still persist. While patient-centered care excels in tailoring treatment plans to suit individual needs, it still inadvertently relegates patients to a passive role in their care journey. A more recent example of this is the racial disparity seen with the prescription of certain blood pressure medications, or anti-hypertensives. Classically, African Americans were thought to benefit from a class of medication called calcium channel blockers, as compared to Caucasians, who were thought to benefit more from ACE-inhibitors. The patient-centered model allowed for this practice to be blindly followed for years before it was ultimately disproven. While this class of medication was technically curated or tailored to a certain population, patients took this advice passively (think patient as passenger rather than driver). I believe that when patients are truly educated on the risks and benefits of available options for their care (informed), they are not only encouraged but equipped to ask why. As a result, they can be put in the driver’s seat of their health and steer for better outcomes, particularly in areas of conventional medicine that would suggest otherwise.

This is where patient-informed care takes stage, poised to bridge this gap by actively engaging patients in the decision-making process, equipping them with basic, comprehensive insights into their health conditions, treatment modalities, and anticipated outcomes. This proactive approach not only leverages physicians for patient-education but also empowers patients to optimize their health trajectories (Street Jr. et al., 2009).

Of course, the melding of patient-informed care into patient-centered care is not without its challenges. Implementing patient-informed care requires a seismic shift in mindset, from doctor-still-knows-best to patient-as-co-pilot. It also requires a substantial change in time allocation for counseling or educating patients during the routine clinic visit - a tall order in a system that often prioritizes speed over substance.

But the payoff? It’s worth it. By empowering patients to become active participants in their care through education, empowerment, and autonomy, we unlock a world of potential that leans into change and ushers in patient-driven healthcare. 

References:

Davis, K., Stremikis, K., Squires, D., & Schoen, C. (2021). Mirror, Mirror 2021: Reflecting Poorly—Health Care in High-Income Countries. The Commonwealth Fund.

Kutzin, J., Sparkes, S. P., & de Ceukelaire, W. (2020). Beyond COVID-19: A whole of health agenda. The Lancet, 396(10243), 559-560.

Centers for Disease Control and Prevention. (2020). CDC health equity. Retrieved from https://www.cdc.gov/healthequity/index.html

World Health Organization. (2021). WHO | World Health Organization. Retrieved from https://www.who.int/

Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I. R., McWilliam, C. L., & Freeman, T. R. (2003). Patient-centered medicine: Transforming the clinical method. Abingdon, UK: Radcliffe Medical Press.

Street Jr., R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education and Counseling, 74(3), 295-301.