What Do Republicans Mean by Patient-Centered Care?

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For many people, going to the doctor’s office for a routine checkup is the last thing on a to-do list. Waiting for an hour to have a 15-minute chat with your doctor can feel like a big waste of time. In today’s medical world, treatment centers around the doctor. You’re on his schedule, following her guidelines, accepting her recommendations and following up with his list of specialists. Appointments, lab work, testing and scans are all done on the convenience of the provider’s schedule – and not without some justification. After all, physicians are physicians for a reason. Specialized training, ongoing education and years in practice lend weight to their diagnoses and expertise.

If you’re like many patients, then you probably don’t think twice about accepting a doctor’s diagnosis and treatment regimen – even if it’s something as serious as cancer. The treatment is prescribed by the doctor, the progress made after treatment is monitored by the doctor and the opinion as to whether or not the treatment was successful is left completely up to the doctor. This is referred to as physician-centered care, and many progressive medical organizations are saying that this process is costing the American health system a lot more money than it should.

The Affordable Care Act sought to correct a lot of broken things about the American healthcare system, but we still have a long way to go in addressing key issues, like the focus of medicine itself. Doctors care about their patients, to be sure, but patients don’t always feel confident or comfortable taking charge of their own healthcare. There’s an obvious gap in knowledge, which leads patients to follow cues instead of being proactive about their care.

What’s Wrong with the Way Things Are?

Let’s suppose that your husband breaks his leg in a skiing accident, and he needs surgery because the break is in several places. While he’s in the hospital, nurses determine what kind of care he receives while doctors and surgeons determine the appropriate course of action for treatment. As your husband recovers, nurses collect vital signs and his doctor comes in periodically to check on the progress. The medical staff makes notes, updates his chart and answers questions as you and he wait patiently – but no one actually consults with your husband or you on how to proceed.
Why would they? After all, you and your husband are just the patients – the word “just” implies that because you don’t have a medical degree or any training, you’re not qualified to offer opinions on alternate treatment options. In the end, you get a release form and a hospital bill (probably a vague one that tells you nothing about what you’re being charged for), and that’s the end of the story.

For the most part, these scenarios end well. Doctors and nurses have specialized knowledge, so they’re capable of making good decisions without input from patients. But what if the patient – in this case, your husband – was more informed? What if his doctors, surgeons and nursing staff kept him abreast of the situation at each turn? This is the idea behind a patient-centered healthcare approach. It’s not just about making sure that patients are treated like people. It’s about ensuring that patients can make well-informed decisions about their own healthcare at every level.

Physician-centered models depend on doctors to do the heavy lifting, from prescribing medications and ordering tests to advising on the best course of treatment. If you’ve ever been diagnosed with a medical condition that has several options for treatment, like cancer or diabetes, then you may understand how difficult it can be to talk to your providers about your choices. While your doctor is busy trying to treat the disease, he may lose sight of how you, the patient, are feeling, both physically and emotionally.
Under a patient-centered approach to healthcare, your husband’s surgery experience may have been entirely different. His medical team would disclose all of the information that they had to you and your spouse, and he and his doctors would work together to develop a course of action that your husband was comfortable with. Instead of wasting time and money on unnecessary medical tests that you don’t understand, you would be given more control over how to proceed.

It’s not about diminishing the authority of qualified healthcare providers but rather including patients in the decision-making process. Patient-centered models benefit patients by increasing the quality of care and overall satisfaction, which in turn benefits providers because patients are more likely to recommend doctors they can trust.

An Ideological Shift that Puts Patients First
The Affordable Care Act is not anti-patient nor against a patient-centered model. Some might argue that the law’s provision covering 10 essential health benefits is very pro-patient since it encourages people to get routine health screenings on an annual basis, covered at no added cost under all new health plans. But the law has done little to change the mentality of the current system, which is still dependent on physicians to make the calls. Republicans want to change that. At the heart of Paul Ryan’s A Better Way proposal is the idea that patients should be able to take charge of their own healthcare, which is an idea that crosses party lines.

In 2012, Mountain States Healthcare Alliance identified 10 guiding principles for patient-centered care, which can be summed up in one sentence: The patient, not the doctor, is the center of healthcare decisions for every situation. This means that the doctor consults with the patient and shares all information to work with the patient in creating a plan for care.

Practical Applications of Patient-Centered Care
Patients who are involved in their own care report that core areas of treatment, such as pain management and recovery at home, go much better. Patient-centered care reduces the number of tests and procedures, and the number of improperly diagnosed medications that patients are given, which takes a tremendous financial burden off the entire medical system.

Physicians benefit from patient-centered care by being able to more accurately treat patients. In patient-centered care, an ongoing relationship with the physician is critical. Instead of treating patients as problems arise, doctors work directly with patients with ongoing health monitoring programs that reduce the severity of illnesses and chronic conditions as they occur.

The old model of physician-based care rarely took input from the most important person in the medical treatment process – the patient. Instead of gaining input from the patient on how treatment was progressing, doctors would fill out self-serving tests that could never uncover the true effects of treatment as felt by the patient.

With patient-centered care, doctors can focus on problem areas, and avoid unnecessary tests and procedures. An ongoing relationship between you and your providers means that dangerous conditions can be discovered early in their development, and costly long-term care might be avoided. On both a practical and ideological basis, this new care method may offer a solution to many of the current healthcare industry’s problems at the patient level.

When Trump takes office in January, he and his Republican colleagues will begin changing healthcare in America once more. Republicans support a patient-centered approach, and while details of their plan have yet to be released – or agreed upon by members of their own party – the shift to a patient-centered healthcare system could be a positive change in direction that the country sorely needs.

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