Patient-driven care instead of patient-centered care

After being part of a discussion at the Institute for Healthcare Improvement today, I have decided to change my profile, above, from this:

To this:


What I am suggesting is that clinicians should do their best to collaborate with patients to understand their needs and desires and to jointly design plans of care that are as consistent as possible with those needs and desires.

I am not suggesting that patients take over the role of doctors and nurses. I also recognize that there are instances in which patients will be unable to communicate their needs. Then a double burden falls on the clinicians -- not only to help cure those patients but also to do so in a manner that would be most sensitive to the likely concerns of the patients.

None of this requires clinicians to assume expertise that doesn't exist on the part of the patients, or to give up their own moral or ethical beliefs or belie their training or experience. Instead, it suggests that, to quote e-Patient Dave, "Patient is not a third person word." Or, as Charlie Safran said in 2004, "I want to note especially the importance of the resource that is most often under-utilized in our information systems – our patients."

In short, it suggests a partnership between patients and clinicians that will allow both to do a better job in carrying out the healing process.

Simple? No. It requires mutual respect, intellectual modesty, a lack of entitlement, and a somewhat paradoxical combination of engagement and detachment that will be hard for both clinicians and patients to carry out. But the upside is huge, for both, if we can learn how to do it.