Blog | Thursday, July 5, 2012

Calling it 'patient-centered care' doesn't solve the problem


The previous orthodoxy was paternalism. It's my way, says the doctor, or the highway.

The current orthodoxy, not stable yet but rapidly developing in that direction, is something called "patient-centered care." Unfortunately, although we can define this term to our heart's content, people tend not to read the textbook.

What if a patient wants to be told what to do? What if a patient wishes to delegate all decision-making to their doctor, and the doctor thinks that's not appropriate? What if a patient wishes to make all decisions themselves but clearly has no insight into their own health? Calling it "patient-centered care" solves none of these issues.

What might help is to provide an instrument, like a survey, to a doctor before a patient's first visit. Use this, we might say to a doctor, and you can help assess to what extent your patient wishes to be involved in decision-making. Or we might give this instrument to the patient. Then, even before the visit starts, we can know how paternalist, patient-centered or something else either doctor or patient wish to be.

Those instruments don't exist yet. Hey, let's make them!

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.