Patient centered care puts the patient at the center of their care. Developing relationships
that are based on trust and respect support interactions that are helpful and healing to
both the patient (and their family) and the care team. As we redesign chronic
illness care it is imperiative to not make asumptions about what an individual patient
needs or wants. When we base our interview technique on what has worked previously with other patients we are perpetuating the current status quo in health care.
I was meeting a diabetic patient for the first time last week. She is a patient in a family practice clinic that adopted changes to improve care to diabetic patients 3 years ago. When I asked her "what concerns do you have about your diabetes?" she responded she is asked that question every time she goes to the doctor and she was getting frustrated and annoyed. She stated that she didn't have any concerns and was also tired of the asumptions that are made about what information she needs to take care of her diabetes. I back pedaled a bit and tried not to make any more assumptions. I encouraged her to share her story with me, a story about her life not just her diabetes. By the end of her story I knew what her concerns were and what information she needed from me. It seems like a leap of faith to let a patient decide for themselves what they need to take care of themselves. I thought to myself "what do you mean you don't want to know the result of your last HbA1C?" (it is currently 11). I realized that by her saying she didn't want to know that number it was not that she didn't care about improving her blood sugar control but that she doesn't want it to be her responsiblity to track. The HbA1C isn't going to motivate her to make changes in her life. She "will do the best she can do and what happens, happens". What will motivate her to change? I believe it is having someone to help her find what she is doing well in her life and support her in what changes she chooses to undertake. We must meet each patient where they are in their chronic illness and through effective communication skills help the patient find their way to better health. No asumptions, canned questions, or one size fits all plans. They only person who can make changes to improve their health is the person with the illness. The type of relationships we develop can support those changes.
