Medicine today is sophisticated, specialised and disease-focused, where healthcare professionals are trained to save lives and maintain function.
The time is ripe to deliver patient-centred care that focuses on choice, dignity and respect. Palliative Care Consultant Dr Rosalie Shaw shares what patient-centred care really means.
The doctor examined the elderly patient, talking to his colleagues as they went through the motion of a ward round. The patient interrupted them politely, “Would you mind changing my bed pan? It’s full and I’m getting wet and uncomfortable.”
Medicine today is sophisticated, specialised and disease-focused, where healthcare professionals are trained to save lives and maintain function. However, in our bid to provide the best possible treatment outcome, we do not always meet the real needs of patients who yearn for compassion and patient-centred care.
Shifting the care focus from the disease to the person can have positive results. It can reduce the number of diagnostic tests and referrals, and enrich a medical practitioner’s life and clinical practice, said Dr Rosalie Shaw, Palliative Care Consultant, and former Executive Director of the Asia Pacific Hospice Palliative Care Network.
According to Dr Shaw, patient-centred care has come to the forefront as there is general dissatisfaction with care, an increase in medical specialisation and the loss of the general physician, rising healthcare costs, an ageing population and disillusioned healthcare professionals.
So what is patient-centred care?
“It is about providing care that is respectful of and responsive to individual patient’s preferences, needs, and values, and ensuring that patient values guide all clinical decisions. The recurring themes are: choice, dignity and respect,” said Dr Shaw.
Patient-centred care is not about appointing more specialised healthcare practitioners such as “dignity nurses”, or for hospitals to adopt models used by boutique hotels with “greeters, greenery and gadgetry”. Neither is it assuming that patients are the best judge of what is needed and leaving decision-making to them without adequate information or guidance.
Instead, patient-centred care is about being responsive to individual patient preferences, needs and values.
In practice, it can mean not leaving the patient to sit in a place they do not want to be, or calling the person by the name of their choice. It can also mean showing respect by ensuring the person is clean and well groomed, and not leaving a patient in a hospital gown, if other options are possible.
Key to patient-centred care is communication. “It is not just about asking the right questions or knowing the right thing to say, it is about giving full attention, about listening, noticing and responding,” explained Dr Shaw.
To implement patient-centred care in medical institutions, some steps include investing in general physicians trained to care for patients with multiple morbidities, and improve continuity of care across different healthcare settings whether it is the hospital, patient’s home or nursing home.
Another approach is to stop measuring things that do not matter to the patient, and to create more patient contact time by eliminating bureaucratic practices that do not benefit patients. To encourage healthcare providers, supervisors should reward patient-centred practices immediately at site through words of encouragement or recognition.
Ultimately, it is about treating each patient as though he or she is your own family member, as though each is an individual worthy of choice, dignity and respect.
Dr Rosalie Shaw spoke on this topic at the Singapore Health Age-Friendly Award Ceremony 2015 at Academia in SGH Campus, entitled "Patient-Centredness- Not just another Healthcare Practitioner or another life-sustaining technology" on 24 November 2015.
The annual Award recognises healthcare professionals for their efforts in making their institutions more age-friendly in terms of people, policies, processes, and infrastructure.
Healthcare professionals from SingHealth institutions, Ang Mo Kio - Thye Hua Kwan Hospital, Ren Ci Hospital, SIM University, and Temasek Polytechnic received awards for the projects they have implemented.