- Patient centered care is not about giving the patient a long list of options for treatment and then expecting them to tell us, the expert, what they want done. It is not in appropriate for patients to expect us to explain things to them, highlight the risks and the benefits to each option and even (and I know this is heresy) offer a personal as well as a professional opinion. Telling an 89 year old lady that she can have an operation or stay in bed and wait for the hip to heal is not giving her a choice. Explaining the risks of surgery balanced against the risks of 12 weeks bed rest allows her to make an informed decision and possible not the one the health care staff would want her to make.
- Providing a patient with paperwork to do under the guise of being 'self-monitoring' is not patient centered care. If we don't expect the patient to share their readings with us on a regular basis (and by regular I mean more than 6 monthly) or are prepared to discuss changes to treatment on the basis of them what is the point. Patients are not stupid and will soon realize that they are being fobbed off with 'busy work' to give them an illusion of control
- Patient centered care is not about listening to experienced patients and then totally disregarding what they tell you. It might be nice for the patient to feel that their practitioner is listening to them but if their experience is not translated into bespoke approaches to care then the entire exercise is futile.
I would suggest it is time that we re-think what we mean by involving patients in their care and do it in a way that is actually practical, useful and impacts on treatment and takes full adavantage of development like mobile techonlogy. For example, one of the major problems underpinning good pain management is lack of both assessment and evaluation of pain treatments. If patients who were able, were encouraged to download a suitable pain assessment app to their mobile phones that they could use whilst in hospital, especially if it were an app that could communicate with the ward technology then it would go a long way to addressing poor pain management and would be actual patient involvement. If people with diabetes monitored their blood sugar using any one of the many monitoring apps on the market they could share that data with their GP's practice and actually be partners in the management of the diabetes.
I understand the nay-sayers will come back with things like 'not everyone has or knows how to use a smart phone' or 'older people do not use technology ' or 'people who are in hospital are too sick to rate their own pain' but a lot of people do use smart phones and would be happy to take that level of control of their illness or disability, the boundaries of what constitutes 'older people' are becoming increasingly fluid and a lot of individuals who fall into that category now have indeed an awareness of and a level of competency in using mobile technology and this tech-friendly population will only increase in the coming years.
I guess what I'm saying is rather than just assuming that talking to patients about their treatment options is the only way to facilitate patient involvement, lets really make patients our partners by giving them responsibilities and according those responsibilities the same level of importance that we give our own tasks. I wouldn't have a problem recording my own blood pressure or blood sugar and just e-mailing it to the surgery every week, in much the same way I wouldn't have a problem using a smart phone app to record my pain scores - I'd be happy to be part of my care especially if it would free up practitioners to look after those patients who actually need their attention in that area
