Patient-centered care 'flawed' with consumer focus

Despite the trend in the catchphrase, "patient-centered care" is a flawed way of putting it, wrote Charles L. Bardes of New York's Weill Cornell Medical College in a New England Journal of Medicine (NEJM) article, published Thursday.

First coined in 1969 by British psychoanalyst Enid Balint, the term implied taking into account a patient's social context to deal with illness. Patient-centered care, however, in today's environment focuses too much on the consumer, Bardes said. The purpose of the patient shifted from obeying to purchasing, now with a strong emphasis on marketing and branding, he explained.  

"If the patient is reconceived as a consumer, new priorities take center stage: customer satisfaction, comparison shopping, broad ranges of alternatives, choice, and unimpeded access to goods and services," he wrote.

Bardes's position is much like an earlier NEJM article by two Beth Israel Deaconess Medical Center physicians who voiced concerns about industrialized patient care. Pamela Hartzband, assistant professor of medicine at Harvard Medical School, and Jerome Groopman, chair of medicine at Harvard Medical School and chief of experimental medicine at the Beth Israel, described hospitals like "factories" and patient encounters like "economic transactions," further explaining that the "consumer" term was inappropriate.

However, others see the trend of patients as the focus as undeniable. Patient-centered care could mean simply looking at the individual, perhaps more appropriately (or inappropriately) named "personalized medicine."

Kent Bottles, senior fellow at the Thomas Jefferson University School of Population Health, said personalized medicine is a trend that healthcare executives can't ignore, in today's Hospital Impact blog post. The important trend is personalized medicine that concentrates on the individual not the population, Bottles said. For example, cancer screening by mammography after age 40 in women and colonoscopy after age 50 in men and women does not take into account the different genetic predispositions for breast cancer and colon cancer in individual patients.

As the debate rages on about patient- versus physician-centered care, Bardes suggested a better term that combines the shared investment in care.

"The flaw in the metaphor is that the patient and the doctor must coexist in a therapeutic, social, and economic relation of mutual and highly interwoven prerogatives. Neither is the king, and neither is the sun," Bardes said. He continued, "Patient and physician must therefore meet as equals, bringing different knowledge, needs, concerns, and gravitational pull but neither claiming a position of centrality."

For more information:
- read the NEJM article
- read the Hospital Impact blog post

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