Patient Centered Care?

Dr. Eberhard Renner
Department Head
Internal Medicine

The lanyard I wear my badge on is imprinted with “Patients First”. “Patient Centered Care” or something the like is on the value statement of almost every health care institution, in Manitoba and elsewhere. It seems a no brainer to unite behind an indisputable value like this. But is there more to it than PR? Do we, individually and as a health care system, really live up to the expectations of our clients in the service industry that health care should be?

I know talking about patients as clients sounds awful to many a physician’s ears, including mine. That said, it can be helpful to occasionally use the word client in lieu of patient.  This is not to distract or eliminate the importance of the patient-physician relationship which remains sacred and pivotal.  It is to remind us that in a service industry, providers are meant to be of service.

As individual providers, most, if not all of us, try hard every day to serve our patients – and some actually go the extra mile and really get there. Kudos! I am not implying that anybody willfully disregards the wishes and expectations of our clients, be it our patients or their families. What I am trying to point out is that our health care system seems to inherently contain multiple systemic obstacles to serve its clients despite claiming this is its primordial goal. The following are just a few illustrative examples; unfortunately, there are many more.

First of all, let me ask you whether you would want to be a patient in your own institution? Be honest. I very much doubt you would want to share a small room, with another, often multiple other, sick strangers, not to speak of a dated bathroom that looks dirty however clean it may be. I doubt you would want to have your history taken, be examined, or hear about unpleasant news brought to you by your care team with only curtains separating you from your fellow patient(s) and their visiting families. And how does the narrow hallway that is usually obstructed with some sort of supply cart and the overcrowded nursing station on our wards affect the care team’s ability to provide “service”? Do our outdated facilities really support “Patient Centered Care”? If this would be a hotel and you would have a choice, as a customer or an employee, would you ever come back? Really?

You may say that these days there is not enough money to build (a) new facility(ies). I am not so sure. Yes, it is correct that we are spending almost 50 cents of the tax dollar on “health care” and it is correct that this is not sustainable. But what are we spending the money for? One thing seems clear to me, whatever we are spending it for is not exactly “Patient Centered”.

How and for what our society spends the available tax dollars for health care is our choice as a collective. If we are honest to ourselves, we can probably all identify many areas where health care dollars are spent without corresponding return of investment for our patients whom our health care system should serve first and foremost. I am convinced that if we are conscious that our health care system is not about us, the providers, but about the clients we serve, about our patients, we will not only be able to identify waste, but also generate the momentum and political will to improve on it and make it better. Maybe one day we will then arrive at a system that truly puts patients first.

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