All posts by Lacey Rose Barre

A New Model of Care: How Should the Medical System Focus on Patients?

In the last decade, many players in the medical community—including health care providers, insurers, and policy makers—have moved towards a model of “patient-centered care”. A 2012 article in Health Affairs provides a good description of the ideas surrounding patient-centered care in various clinical specialties:

http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/

While the model was designed to save money while improving patient care (as most healthcare initiatives are designed to do), the patient-centered care model employs a focus on improving the doctor-patient relationship through better communication and increased empathy; physicians who practice patient-centered care employ tools that continually question “patients to assess their needs and the effectiveness of the care they are receiving.” Not only does this model produce better health outcomes, but patients often report reduced symptoms and a higher degree of overall satisfaction.

This kind of relationship is detailed by Danielle Ofri in her 2013 book “What Doctor’s Feel”, described below:

http://www.nytimes.com/video/science/100000002281755/the-doctor-patient-relationship.html

In chapters 14 and 15 of “The Illness Narratives”, Kleinman presents “a practical methodology in the care of the chronically ill… captured by the words empathetic listening, translation, and interpretation… meant to counterbalance, not replace, the standard biomedical approach to the treatment of disease processes.” While Kleinman’s ethnographies were written decades before the concept of patient-centered care became mainstream, his ideas are clearly in line with this model of care. While these ideas are promising and appealing (and working well in many healthcare facilities), the reality of many healthcare systems is that it is incredibly challenging to balance this kind of care within the time constraints that most physicians face. Where should the line between completeness and efficiency be drawn in the doctor-patient interaction? How much of this burden should be placed on the physician, and what parts of this model might best be relegated to other clinicians (like nurses or physician’s assistants)?

Livingston’s Chapter on “The Moral Intimacies of Care” in Improvising Medicine describes many of the same issues, but in a medical system where nurses often provide the primary care-giving. While the emotional component of care-giving is potentially more important in an oncology setting than it is in acute care settings, the discussion of empathy, morals, hope, and faith is certainly pertinent to many other specialties, especially primary care. If we could create an ideal patient-centered care model, what would the role each member of the care giving team be?

Many medical schools, including Brown’s Warren Alpert Medical School, are encouraging this kind of empathy training during their medical training. Last year, an art exhibit called “Beyond the Diagnosis” was featured at the school and encouraged the humanization of patients.

http://www.browndailyherald.com/2015/02/20/med-school-exhibit-takes-people-first-approach/

Compared to Good’s description of the dehumanization of the medicalized body in “How Medicine Constructs Its Objects”, how could this kind of training improve the type of care that new physicians provide to their patients? Can medical schools teach the appropriate balance of empathy and clinical detachment ‘necessary’ for effective care and treatment?