“Those essential moral questions that plague the sufferer of serious, disabling illness – ‘Why me? Why now? How can I go on with my life?’ and even ‘Who am I now?’ – are precisely the ones biomedicine sidesteps.” Cheryl Mattingly, 1998
In a Perspective published in AJKD, Ann O’Hare discusses the important concept of patient-centered care in nephrology. As defined by the Institute of Medicine, patient-centered care is “care that is respectful of and responsive of individual patient preferences, needs and values.” In this article, O’Hare beautifully highlights the challenges we face as nephrologists in achieving the patient-centered care for all our patients.
A recent article from Canada by Bear et al reviews the literature in nephrology regarding patient engagement and patient-centered care in the management of advanced chronic kidney disease (CKD). Evidence exists that, currently, the care of patients with advanced CKD and ESRD is not fully patient-centered or fully supportive of the patient experience. The authors noted a number of barriers including but not limited to:
- Conflict with other priorities
- Lack of training and fear of change
- Unequal balance of power between patients and providers
- Physician culture and behavior
- Fee-for-service model of physician compensation
- Slow implementation of electronic health records
- Fear of accountability
These are similar to what O’Hare discusses as she lists five overlapping and self-reinforcing pillars of being a good physician:
- Taking enough time
- Going above and beyond our job description
- Providing good care by upholding the patients’ individual values
- Valuing the relationship
During medical school, it is universally emphasized to listen to, spend time with, and build a valuable long-lasting relationship with your patient. In the midst of a busy residency, fellowship training, and academic or private practice career, these important concepts may be neglected.
The basic tenets are important not only for patient care, but also for physicians as well. Patients appreciate the chance to tell their story, and allowing them to do so intrinsically improves their trust in their provider. Physicians will benefit from better communication and understanding of their patient’s needs. Atul Gawande recently described how a strong relationship with doctors benefits the health of patients. Patients live longer and are hospitalized less. But I believe it works the other way, too. When I see “Mr. Jones” on my list of patients on Monday, I am excited to hear about the next business deal or “Mrs Smith” who will tell me about the book she is writing. These conversations go beyond performance metrics that urge quantity over quality. As Dugdale puts it well, “If you care for your patients as friends, a 20 minute visit is too short!”
Technology has entered the medical world and has allowed for more efficient care. However, O’Hare’s five principles will fail if you are sitting in front of a screen with your eyes on the screen and not on the patient. Take the time to sit quietly with your patient in the office and have a nice conversation. Get to know them, and let them get to know you! Put the keyboard down, take your eyes off the screen, stop your phone texts (and your Twitter feeds!) for 20 minutes – you won’t regret it!
Burnout among physicians is on the rise. A recent series of articles in CJASN discussed burnout and wellness in nephrologists. Sharing and caring for the patient with their stories, getting to know them better, and valuing their relationship has the potential to reduce physician burnout and re-energize your love of medicine.
How can we battle the current constraints of medical practice that is RVU-based, with limited time availability for our patients? I think if we follow the five rules from O’Hare, listening to and learning about our patients’ stories better and building those strong relationships, we can win this battle together; the patients can be our colleagues in this effort. These changes will be difficult, but enacting O’Hare’s concepts will likely yield rich rewards for both the physician and the patient.
Title: Patient-Centered Care in Renal Medicine: Five Strategies to Meet the Challenge
Author: Ann M. O’Hare