Being Provider-Centered in order to be Person-Centered

This story is a bit on the personal side. I’m tired, and it’s affecting my ability to deliver?person-centered care.?I’ve been waking daily at 4am to write for my PhD for 2 hours. Then it’s off to the clinic I go, somewhat frustrated at what little I managed to get accomplished, and without that clarity with which I usually begin my day. I’ve recently started this trend, but I’m not sure it’s working so well.

Prior to this, I was waking at 5am and spending half an hour of quiet time, doing a little meditation with a cup of coffee before heading to work. However, with this new attempt at creating more PhD writing time, something in my day had to give. Unfortunately, I sacrificed my meditative, clarifying moments in the morning…and I’m tired, admittedly frustrated, and with a sensation of what I can only describe as a dense tension in my brain.

Last Thursday, my final appointment was a new evaluation. I found myself struggling to engage the patient, struggling to probe deeply into the patient’s story to understand her case. Try as I might with every sinew of my being, with every neurone in my brain, I just did not have it in me. I was horrified as I recognized my slip into an abysmal biomedical approach to my poor patient’s interview. It was a familiar approach, one I’ve used many times in the past, and one which I once thought was THE way to practice. But, having seen the value of a person-centered approach, I hadn’t gone the impersonal biomedical route in years, and I was surprised at how easily it came to me.

On my traffic-filled drive home that day, I had sufficient opportunity to reflect on what happened in that painful evaluation. It takes energy to actively listen to a patient, to empathize, and to learn about their life experience. It takes energy to engage in dialogue with your patient about how best to incorporate all that information into a mutually agreed-upon treatment plan. It takes so much more energy to be person-centered, than to be provider centered in the approach to care, at least for me. The biomedical approach comes like a thief in the night on a wary, almost cataleptic clinician, in an unwelcome return to the foundation of our impersonal healthcare training.

This leads me to the lesson from this experience. Sometimes we do have to be provider-centered, but not in the way you may be thinking. I’m not talking about being provider-centered with our patients. What I mean is that we need to be provider-centered outside the clinic in order to be person-centered when we are in the clinic. In other words, we need to take care of ourselves so we can effectively care for our patients.

So maybe my new early-morning schedule is not working for me. It is definitely not allowing me to get sufficient sleep, nor is it permitting my valued “centering” time before I head to work. I write best in the morning, so I don’t necessarily want to give up my early morning writing. However, I’m going to have to change something. Maybe I will attempt to get to sleep earlier, but this may require my family to adjust a bit. Regardless of how I decide to care for myself, it must allow me the focus and energy to be person-centered even with my last patient of the week. Healthcare providers are people too, and we need to ensure that we are good to ourselves.

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