Looking after our patients
Think about the different factors that impact on decision making and we could be here all day. How much information do we have or what information do we need to get in order to decide? What choices are available to us? What are the risks and benefits of any course of action? What is the risk of doing nothing? All of this is in our head and we need to discuss with our patient, their parent / guardian or in the case of animals rather than humans, their owner. I know that some of you are medics and some are vets, but I want to compare both – it does make writing about patients and owners confusing, so maybe I’ll use the term patient / relative / owner (PRO).
Shared decision making brings in the wishes of the patient / relative / owner. Communication skills all impact on how well this goes and hopefully understanding of the situation. Time and financial constrains then add to the list of concerns.
We all know this. So why am I talking about all of this again? Well today, I wanted to think about patient centred care. Or in the case of animals, owner centred care. I’m thinking here about feelings, emotions and wishes for the course of medical or surgical management, and treatment – either from the patient themselves or the other person / human that is associated with them.
Picker presented 8 Principles of Patient Centred Care namely:
Respect of patients’ preferences (or relative or owner) Co-ordination and integration of care Information and education Physical comfort Emotional support Involvement of family and friends Continuity and transition Access to care
If we think about these for a moment, respect for the preferences of the PRO relates directly to shared decision making. What is going to happen needs to be discussed with the PRO and a plan agreed – this involves imparting information (taking on a paternalistic standpoint), but only for the effect of teaching about the subject and ensuring that information consent can be gained.
Within human and veterinary medicine modern methods mean that it is not uncommon to see more than one clinician during work up and treatment for any condition. Referral is common to access the most up to date knowledge, diagnostics and skills. But there needs to be communication between all these partners. It is no use if the referral surgeon doesn’t feedback information the general practitioner or vice versa. Record and keeping, storage and who has access to a patient’s records can all impact on this. Policies and procedures need to allow fast, efficient communication to follow the patient.
If people feel more involved in the care that is being delivered they are more likely to follow the advice, be willing to talk to clinicians and ask questions where there is doubt. Patient centred care leads to a level of trust between clinician and PRO. But at what cost? How much more time is needed to deliver this level of care. Can it be delivered adequately in a 5 or 10 minute consultation? Is private or referral medicine merely a route of people being given more time and attention, but this costs more.
In the 21st Century people are ever more demanding, and with the advancements in modern medicine, it would appear morally right that everyone should have access to this. But how can that be delivered to a population that is also increasing and where the demand for skills clinicians doesn’t keep pace?
We need to deliver patient centred care.
The question is, how do we do that?