Patient-centered medicine is important for patients and physicians alike. Patients help steer the treatment and care they receive. Physicians are relieved from the burden of having to be godlike guardians of life and death. Both are able to dialogue about what the best course of action might be for this particular patient.
Yet in spite of the general effectiveness of patient-centeredness, write Dr. Edward Krupat, et al.,
it is reasonable to ask whether a one-size-fits-all approach to patient care is the best one.
Writing in The Journal of Family Practice, Krupat et al. measured how alike a patient and physician’s beliefs on power sharing are. They then measured the patient’s trust, satisfaction, and their “endorsement”, that is, how likely the patient was to return to the physician and follow their advice.
What isn’t terribly surprising is that patients who want their physicians to take charge trust and endorse physicians who tend to be less patient-centered. It also isn’t terribly surprising that if a patient’s views on patient-centeredness are mismatched to the physician’s views, they will trust and endorse that physician less.
There are, though, some surprising elements.
Physicians’ mean scores [on the questionnaire measuring patient-centeredness] were significantly higher than those of the patients … indicating a stronger belief in sharing power and information. It turns out that patients’ scores ran the full gamut from physician-centered to patient-centered, but physicians’ scores were
somewhat more constricted and consistently indicated a patient-centered approach.
This study also had some interesting findings about age:
Contrary to the stereotype that older physicians take a more authoritarian orientation toward patient relationships, the data suggest that patients seeking a physician who values information and power sharing are likely to be disappointed if they merely use physician age as a proxy for patient-centeredness.
Also, with regards to patients, Krupat et al.
found a somewhat unexpected pattern for age: There was little difference [in patient-centered preference] among the 3 youngest categories (18–39, 40–49, and 50–59 years), and then relatively sharp drops among those in their 60s and older.
The other findings of note are that patient-centered patients — whether they are matched with an equally patient-centric physician or not —
were both significantly less trusting and less likely to endorse their physicians. Lastly,
visit satisfaction was not significantly related to any party’s patient-centeredness.
The authors themselves touch on the reason I think the results came out the way they did: all the patients in the study
had an ongoing or worsening problem that concerned them. Patient-centeredness can’t be the only solution to improving care, because in the middle of a grave health concern, sometimes a patient wants a doctor to take charge. In the middle of a crisis, sometimes the phrase, “Here’s what we’re going to do…” is the most comforting thing a person can hear.
What this particular study can’t tease out of the data is when to take charge, and when to take a shared approach. The data Krupat et al. present indicates that patients over 60 seem to prefer a less patient-centered approach. The results also indicate that patients who are themselves patient-centered are more skeptical of the care that they are about to receive.
All in all, though, I think this paper is a cause for hope. The findings indicate that most physicians really do want to talk things out with patients and find what’s best for them. Physicians want to be doctors, not gods. If anyone wants doctors to be gods, it’s patients, which is certainly understandable in a moment of need.
The fact that patient- vs. physician-centeredness can’t predict patient satisfaction with certainty is also cause for hope. No healthcare professional can always take the approach which the patient will find most healing. The data, though, shows that each patient visit is another opportunity to get closer.
The article reviewed: Krupat, Edward, Robert A. Bell, Richard L. Kravitz, David Thom, and Rahman Azari. 2001. “When Physicians and Patients Think Alike: Patient-Centered Beliefs and Their Impact on Satisfaction and Trust.” Journal of Family Practice 50 (12): 1057–62.