“Tao (pronounced “dao”) means literally “the path” or “the way.” It is a universal principle that underlies everything from the creation of galaxies to the interaction of human beings. The workings of Tao are vast and often beyond human logic. In order to understand Tao, reasoning alone will not suffice. One must also apply intuition.” — Derek Lin
Patient-centered care (aka client-centered care, patient-directed care, patient-driven care, etc.) has infused the published descriptions of today’s healthcare industry and professions. National and world health organizations include patient-centered care as a hallmark of best practice. A casual medical database search of this term immediately yields articles in journals of nursing, dentistry, medical devices, surgery, social work, hand therapy, health management, primary medicine, behavioral medicine, rehabilitation, emergency medicine, mental health, occupational therapy, and many more.
Yet, according to the same body of literature and my own observations, truly patient-centered care remains largely unpracticed. It consists of attitudes and actions that can be a challenge to live up to, an ideal to be ever sought and only attained through practice and diligence.
True story: A 17-year-old girl was admitted to a hospital psychiatric unit with terrifying hallucinations and delusions. She wept copiously and had not slept for days. She continuously prayed aloud or ruminated about having brought the Zika virus into the world. Her parents, immigrants from South America, were distraught, and asked to have their priest perform a rite of exorcism as soon as possible. The patient and parents were counseled about the neurobiological nature of schizophrenia and importance of medication, but remained firm in their request. The psychiatrist and team made this possible by providing a private area for the ceremony to take place, and interacting with all involved parties in a calm and respectful manner. Immediately after the priest’s intervention, the patient and family were willing to initiate psychotropic medications. The girl’s symptoms abated and within the week she was able to go home and remain stable with follow-up care and medications.
This team provided patient-centered care. To be sure, not everyone was comfortable or happy about having what (to some) was a primitive, outrageous, unscientific and/or inconvenient intervention, but all supported doing what they could to meet the patient’s stated needs. The resulting trust and relief were powerful in the patient’s recovery and engagement in aftercare.
“To be sure, not everyone was comfortable or happy about having what (to some) was a primitive, outrageous, unscientific and/or inconvenient intervention, but all supported doing what they could to meet the patient’s stated needs.”
One can only imagine the possible repercussions had word of this unconventional healing approach been somehow made known outside of the team, if other patients had become upset, had staff members taken their objections to Human Resources, or any number of other problems occurred. It took the team-members’ courage and commitment to be patient-centered in this instance.
The essence of patient-centered practice:
- The patient/designated spokesperson is the expert on him- or her-self and the chief decision-maker.
- “Nothing about me without me.” All evaluation and intervention decisions should include the patient and/or his or her designees.
- It is the professionals’ responsibility to assure that each patient and family understands their health conditions and evaluates the options at the level and in the ways that best fit their learning styles and preferences.
- Professionals trust patients and their families to make choices that fit themselves and their circumstances.
- The professional team ultimately acts upon the patient’s stated wishes to the best of their ability as long as these are within their professional scope of practice, standards and ethics. We work for our patients.
Reading this, you probably appreciate how challenging it can be to walk the way of patient-centered care, especially if you work in a setting where everyone is not fully on-board. Being patient-centered requires open-mindedness, flexibility, asking good questions and listening, comfort with uncertainty and controversy, and letting go of control. The investment may be great, but the results are often amazing.
Patient-centered care empowers those we serve and increases their sense of ownership of and investment in their health care. Through its practice, patients are assured of our respect and the opportunity to deeply influence their own care at a time when everything else in life may seem frighteningly out of control.
When I see clients in my occupational therapy practice, most often they have never interacted with a professional in a client-centered manner. They often start out feeling a bit confused or disbelieving when I say, “You’re my boss.” Once they catch on, though, they light up with confidence and purpose. By using a client-centered approach, I have seen people transform from passive, wary, and pessimistic into feeling excited, hopeful, and willing to try new treatments. The client-centered process is itself therapeutic; the learned skills and practice opportunities are an added bonus!