The concept of patient-centred care and shared decision-making has become an important topic in healthcare and cardiovascular medicine. Dr. Martha Gulati
, Editor in Chief of ACC's (American College of Cardiology) Cardiosmart programme says, "Health care professionals need to understand the goals of their patients and vice versa, which establishes reasonable expectations for both the patient and the physician. The goals established in such a collaborative manner will improve patient satisfaction and empower patients to have some control of a chronic condition – living with their disease but on their terms."
It is ironic that when you think of healthcare, you automatically think of the patient. But even then, we have to emphasise on patient-centred care, and people have to be reminded of the fact that it is the "patient" who matters as far as medical care is concerned. Why is that so? Why do we have to be reminded of the fact that it is the patient who is important and nothing else? The answer is simple. Healthcare systems today are designed to provide "disease or system-centred care" and therein lies the problem.
We’ve come a long way from that traditional image of a doctor – a stern and intellectual individual, looking down at the patient through their beady eyes, expecting them to simply listen and obey. Those days are gone, and today, when patients meet their doctors, they are well-equipped with health information related to their condition. They also have an opinion (right or wrong) about the different treatment options as well as a very clear idea as to which treatment they prefer and which they would rather not have. So how do we achieve a balance between what the doctor thinks is right and what the patient believes is their right?
We can do so by first understanding patient-centred care. Baliant
describes it as "understanding the patient as a unique human being."
Mead and Bower
highlight five core dimensions of patient-centred care:
- Taking a biopsychosocial perspective (that patients have a family and environment that is also affected by their health)
- Viewing the patient as a person (that patients are not just a name or number but actual human beings)
- Sharing power and responsibility (that patients can and should have a say when selecting the best course of treatment)
- Establishing a therapeutic alliance (that healthcare providers take out the time to know and engage with the patient)
- Viewing the doctor-as-person (that doctors have the best tools available and are the ideal partners to work with patients in pursuit of wellness)
All this sounds really good in theory but what is the practical implementation? As far as cardiovascular medicine is concerned, patient-centred care is being cited as critical for positive patient outcomes. However, there are certain barriers
that are preventing it from becoming the new model of healthcare. These barriers include:
- Lack of formal training for trainees and early career cardiologists.
- Lack of standardised evaluation criteria with respect to patient-centred care practices
- Lack of proper integration of a patient-centred approach
If patient-centred care is the way to go, it is time to walk the talk. The American College of Cardiology (ACC) emphasises on the need for trainees to develop a patient-centred approach to cardiovascular care. Patient-centred care is also listed as a core competency of professionalism in cardiovascular care. In other words, patient-centred care is an essential skill for healthcare providers in cardiology. But if you really want to see evidence of it in everyday clinical practice, it is important to incorporate the principles of a patient-centred approach in cardiology fellowship training programmes. When patient-centred initiatives become part of training institutions, they will automatically become part of the healthcare system.
The new buzzwords at congresses, in journal articles, blogs, and podcasts seem to be nothing but "shared decision-making, patient power, personalised care, patient-centred care" etc. The concept in itself is powerful enough to create a hashtag revolution. Research shows that search for PCC (patient-centred care) produces more than 20,000 results
. There are over 2000 publications annually on this subject alone. But the only way patient-centred care can move from being a "buzzword" to actual reality is when healthcare professionals in cardiology incorporate the principles of patient-centred care into their daily practice. Only then will we be able to deliver patient-centred care