Blog | Wednesday, July 17, 2013

The right care, at the right time, for the right person


It's commonplace now to say that medical care needs to be patient-centered. But what does that mean? How do we make sure that the doctor's advice is tailored to the person in front of them? Part of what I argue in my book is that true patient-centered medical care has to be based on a relationship with the primary care provider, which in turn is dependent on good communication. But there's another dimension: the medical care proferred has to be modified based on the person's individual, unique needs. Medicine is not one size fits all. Every rule can be bent, every guideline can be remixed based on the person talking to the doctor at the moment.

But how are we to get there? And does it make a difference?

In a recent article in the Annals of Internal Medicine, Saul Weiner and colleagues, from Duke and the University of Illinois at Chicago, defined this necessity, calling it "context-dependent care." In their study, patients surreptitiously recorded physicians, and the resultant recordings were analyzed to identify whether doctors appropriately modified their care based on contextual clues provided by the patient. For example, a patient with presumed hypothyroidism might also have depression; a patient who needs insulin may be unemployed and homeless, needing some creative solutions to getting them their medication.

The result of their study? Such modification of care plans according to context actually improved care outcomes. This is an interesting finding, but I think the bigger-picture advance is to recognize what patient-centered care actually is: not a mere elicitation and application of "preferences" (Ms. Gomez, do you prefer X or Y?), but a translation of the care plan into the patient's world, with all the complications and nuance that entails.

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.