Patient-Centred Care

A theme that arose this week during both morning report and my Rapid clinics was patient-centred care.  During morning report, the senior from overnight was summarizing the patients that were admitted.  For each, we reviewed relevant clinical pearls as well as how we could tie in patient-centred care.  One of the patients that was admitted was receiving nutrition via total parenteral nutrition (TPN) at home.  The patient presented to hospital severely dehydrated after missing a few days of TPN.  Rather than assuming the patient was not adherent, it was gathered on history that she did understand the importance of TPN but was having difficulty with it at home.  The solution here that that the team could implement on discharge would be to ensure that the patient had adequate home supports and CCAC to help her with TPN.  In scenarios like this, our role as care providers involves exploring the barriers and obstacles that our patients face in their health care journeys.

Patient-centred care has been defined as a concept that integrates patient interests and the personal contexts of patients’ lives into their care; their wishes are honoured and respected during their experiences with the health care system. (Epstein et al., 2011) Epstein et al. discussed some techniques that can been taken to accomplish this.  For example, communication styles that invite patients early on to ask questions about their conditions promotes this concept.  (Epstein et al., 2011) Patients and health care providers perceptions of an encounter may be different.  A recent study by Montague et al. surveyed various health care professionals and the public to identify factors that contribute to patient-centred care.  (Montague et al., 2017) The public valued “timely and readily accessed care” provided in a “caring respectful context” with decisions made in partnership with patients and providers and with a framework that care should be “based on need and not the ability to pay.”  (Montague et al., 2017) Health care professionals agreed with the above with an additional emphasis on “care influenced by evidence and expert opinion.”  (Montague et al., 2017)

An example of patient-centred care that I encountered was during my Rapid clinic in which we had a patient referred to us from the Emergency Department with some abnormal enzymes on blood work.  Upon further history and inquiring about medications, it was apparent that the patient was consuming a number of additional supplements that could be contributing to the blood work abnormalities.  We went through all them in detail and counseled the patient on our recommendations for what would be safe to take.  While doing this, we kept in mind what he valued in his life, what was important to him, and why he was consuming these supplements in the first place.  This helped navigate the discussion and get to know the patient better.

My preceptors exemplified a number of qualities that were helpful in providing effective patient-centred care, and I hope to emulate them as I moved forward in my career.

SH

Resources:

1. Epstein, R. M. et al. (2011). The Values and Value of Patient-Centered Care. Ann Fam Med, 9(2): 100 – 103.

2. Montague, T.  et al. (2017). Patient-Centred Care in Canada: Key Components and the Path Forward.  Healthcare Quarterly, 20(1): 50 – 56. doi:10.12927/hcq.2017.25136