NEJM: Patient-centered care poor solution to doctor-centered care

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Patient-centered care may work as a conceptual solution to concerns with quality and cost of healthcare, but it sacrifices providers’ autonomy, patients aren’t positioned to make cost-conscious decisions and it may still be costly, Charles L. Bardes, MD, wrote in the March 1 issue of the New England Journal of Medicine.

“As a form of practice, it seeks to focus medical attention on the individual patient's needs and concerns, rather than the doctor's,” wrote Bardes, of the Weill Cornell Medical College in New York City. “As a rhetorical slogan, it stakes a position in contrast to which everything else is both doctor-centered and suspect on ethical, economic, organizational and metaphoric grounds.”

Bardes traced the origin of the term “patient-centered care” to 1969, when a British psychoanalyst conceived the concept as an alternative to “illness-oriented care” that would “take into account the patient, the social context in which he lives and the complementary system devised by society to deal with the disruptive effects of illness.”

Now, as the healthcare industry seeks ways to reign in costs and improve the quality of care, “patient-centered care” is becoming the trendy solution to “doctor-centered care,” but Bardes advised others to consider what “patient-centered care” actually means.

Patient-centered care models would deliver the focus of care from costly specialists to primary care providers for the purpose of care coordination, but the comprehensive services offered in the model, including those of specialists, are costly themselves, Bardes wrote.

Additionally, patients can’t be expected to make cost-conscious decisions because they aren’t always direct consumers of healthcare, according to Bardes, who added that his own patients have demanded advanced diagnostic imaging and brand-name medications when they weren’t necessary.

Bardes concluded that healthcare professionals should begin conceiving of a delivery model that is neither “doctor-centered” nor “patient-centered,” but something that considers both parties.

“The patient and the doctor must coexist in a therapeutic, social and economic relation of mutual and highly interwoven prerogatives,” he wrote. “Health relies on collaboration between the patient and the doctor, with many others serving as interested third parties. Patient and physician must therefore meet as equals, bringing different knowledge, needs, concerns and gravitational pull but neither claiming a position of centrality.”