Patient centered care? 4 perspectives in 4 weeks

For this week's newsletter, I intend to shift the focus towards enhancing patient care. While the prevailing trend leans towards consumer-centered care, I personally advocate for patient-centered care. In my view, patient-centered care prioritizes patients' well-being and acknowledges the holistic requirements of all patients. It extends beyond merely acceding to patients' demands, encompassing a deeper understanding of the concept, one that is not synonymous with on-demand care.

The infographic presented above is based on a 2017 survey for parents seeking care for sick kids. Does it adequately reflect the principles of patient-centered care, or have there been substantial improvements in the past five years? Nope.

I find it somewhat ironic that many LinkedIn and other social media commenters often believe that doctors fail to comprehend the needs of their patients. What's peculiar is that doctors, including myself, also step into the role of patients and navigate the same healthcare system as everyone else.

To offer valuable insights into healthcare reform, I believe it's crucial to share my perspective on what I consider patient-centered care. I approach this topic from multiple vantage points, including that of a patient, parent, pediatrician, and pediatric ER physician. By exploring these perspectives, we can begin to address the gaps and misalignments within our healthcare system.

Ultimately, patient-centered care should be our collective goal, guiding every action, investment, and initiative. After all, we are all patients and wish for our care to revolve around our needs. Don't we?

From the standpoint of a patient, I've noticed that many LinkedIn posts revolve around the concept of patient-centered care, with a common theme being the empowerment of patients. The idea of giving patients more choice, advocating for the adoption of digital health solutions, or the endorsement of remote patient monitoring wearables often takes center stage. Patient satisfaction is often hailed as the most critical quality metric. It's widely acknowledged that patients desire more time with their doctors. However, as a patient, I perceive things somewhat differently.

In my role as a patient, I've observed that my own care has undergone some changes. I have a primary care physician, access to a patient portal, and an answering machine for queries. I see my physician annually and utilize a local pharmacy for immunizations. All seems to be in order. I typically wouldn't call if I'm unwell since, as a physician, I know how to address minor issues.

With age, I've developed certain medical conditions, which were detected during my annual physical check-ups where vital signs and blood work are routinely conducted. I have around 30 minutes with my doctor during these visits, which usually entail repetitive questions, him typing on his computer, and recommendations regarding weight management or new medications. For more complex issues like high blood pressure, snoring, knee injuries, atrial flutter, and hearing problems, I'm referred to specialists. Once referred, they become responsible for that aspect of my health, and my primary care physician may not have access to the results until my next annual visit.

What has surprised me the most is my diagnosis of hypertension during a follow-up visit to my cardiologist, who prescribed medication 18 months ago. I wanted to switch medications due to the side effects of the initial prescription. In those 18 months, no one inquired about my blood pressure, whether I was taking the medication, or if it was effective. When I requested a refill, I had to navigate through a second portal and voicemail to reach my cardiologist.

Recently, my primary care patient portal malfunctioned, and despite numerous attempts to reset passwords and emails, the issue persisted. I even accessed my portal from ten years ago when I lived in another city. After contacting the office, I received a tech number to call and resolved the issue. However, it broke again, leaving me frustrated.

Does this healthcare model truly embody patient-centered care? Should I expect nothing more than an annual visit, medication adjustments, and the same discussions until the next year? Don't get me wrong; I hold my doctor in high regard. He is well-trained, experienced, and knows his field. He remembers me during visits, and the office staff is excellent. I understand the value of annual check-ups, which allow me to gauge my progress, especially with lab results and EKGs. It's certainly better than not having it, so I will continue.

But I can't help but wonder if it will become increasingly challenging as I age, given my observations of my 90-year-old mother's experiences. She has transitioned from having a primary care physician to a concierge doctor and now visits an urgent care center for primary care. She has more specialists than most hospitals, and sadly, her primary care doctor rarely checks in, often suggesting calling an ambulance or heading to the ER. Once at the ER, she is usually transferred to a different hospital, where her medications are changed, and she follows up with specialists. This cycle repeats frequently.

As for me, I juggle multiple patient portals, and each of my doctors has a different one. I lack a consolidated record of my blood pressure, weight, cholesterol, and other vital health data. To obtain medication refills, I must contact each specialist. My primary care physician primarily handles well-care, while others address acute issues and chronic conditions. These aspects remain disjointed, with no connection between them. I reach out to my healthcare providers only when I need something. My only interactions outside of appointments are appointment reminder texts and completing repetitive pre-registration forms.

Does this model truly qualify as patient-centered care? It certainly doesn't feel like I am getting any patient centered care. What happened to those days?

So, what do I desire when I am the patient?

I want a primary care physician who takes responsibility for my overall health.

I want easy communication with the front office through text, the patient portal, voicemail, or even in-person visits.

I expect regular progress checks between my annual visits.

I want seamless communication between my primary care physician and other specialists or consultants I have seen. This includes sharing information about their recommendations, my actions, and ensuring there are no conflicting instructions.

I want all my healthcare providers and caregivers to be on the same patient portal, eliminating the need for me to juggle multiple portals. I want all my health data to be shared among them, accessible in one place.

I would love to not have to call for prescription refills. You prescribed the medicine I take daily how hard is the math to tell when I will run out?

I do NOT want my doctor to provide guidance on exercise, nutrition, mental health or other areas that fall outside his expertise.

I want the option to be seen when necessary, whether it's an in-person visit when I'm unwell or telemedicine consultations when in-person visits aren't needed.

Test results, follow-up appointments, and other medical interactions should be conducted through phone calls or video chats with nurses or doctors.

I expect my healthcare provider to acknowledge my progress, hold me accountable if necessary, and guide me towards better health.

I would love my practice to at least reach out to me if I am admitted to the hospital, talk to my admitting physician and communicate with them before they send me home.

I'd love to have a primary care team that empowers me to take charge of my own health. While I understand that my health and choices are ultimately my responsibility, a collaborative approach could yield better results.

This is what I envision as a patient-centered experience. What are your thoughts?

(Note I used "he, his or him" as my primary care physician is and always has been male and in no way trying to be sterotypical or biased)

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes. Edited with ChatGPT.