Patient-centred care

A term that, so far, has manifested only in self-promotion, academic publication, and career advancement. Not much seems different for patients. The term has become the mantra for a new generation of doctors that believe they’ve upended the paternalism of their predecessors. The proposed movement is intent on including patients in the decision making process with regards to their own medical management rather than simply telling them what is going to happen, or better yet, having them sign on the dotted line and breathe deeply into the mask.

Reflecting on the infancy of my clinical career in medicine I can say there has been a scarcity of patients giving the orders. On my first week of inpatient pediatrics I spent 5-10% of my days at the bedside and 90-95% scouring online records and medical resources, meticulously writing down urine outputs and overnight oxygen saturations as my colleagues at various levels on the medical hierarchy did the same to ingratiate themselves to the ones above them and secure their status from the ones below them (that is – me). Children are woken up and examined upwards of 5 times each morning as each team member takes their own notes for ‘pre-rounds’ so they’re prepared for the main rounds later on. During this completely inorganic act, the child’s diagnosis, course in the hospital, and ongoing problem list is presented to the group as if the child isn’t there – in fact, as if he isn’t even animate. The kid lies in bed, wondering why a group on strangers is standing between him and his Xbox and why he continues to be confined in this brightly coloured prison.

There are notable exceptions to the rant above; certainly many of my supervisors have been exemplary models of compassion and effective communication, but the majority of medicine practiced in academic hospitals still feels disconnected from the patients. It would be pretentious as fuck to say that the system is completely wrong, that the entire established practice of western medicine is inherently flawed, or that I have a solution to propose; I`m certainly not clever or brazen enough to say that. However, I will say that the system is a product of its composition. The majority of my classmates, the doctors of 2014, often display entitlement and a lack of grace. They (and I) haven’t the slightest appreciation of how fortunate we are to be born into upper-middle class strata and thrust into the supportive environment that has enabled our easy path through life. We stand tall reflecting on our achievements and our (presumed) earned acceptance into the prestigious medical community. As soon as we step foot into the institution, we forget about the ideals we temporarily donned during the application process and immediately start scheming toward the attainment of the best possible career (as judged by compensation and prestige, not by community service).

If we want to start practicing patient-centred care, we should start training students who can relate to patients. Real patients. People who are focused on salvaging marriages and paying rent, not on quinoa salads and cross-fit. There is a small movementin some US schools toward more holistic selection of applicants. Boston University has begun selecting applicants based on life experiences, socioeconomic status, and cultural and ethnic backgrounds rather than GPAs and MCAT scores and the results have been positive. I won’t go into detail, but the linked article is worth a read. I’ll end the cynicism by encouraging readers, and reminding myself, to consider the factors that have led to our current statuses and how we can serve those less fortunate.

NJCB

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