The Relationship and Patient-Centered Care
A Message from Tom Dahlborg
Vice President for Strategy and Project Director
I blog at Hospital Impact, which is written by and for hospital executives, physicians and other healthcare thought leaders.
The feedback on my latest post, "Data shows most healthcare comes from relationships," has been overwhelming and informative. In essence, I argued that patients heal best when a healthy relationship with their healthcare provider is in place.
I heard amazing healing stories since writing this post that would not have been if it were not for the authentic human connection between a patient and a healthcare professional. In just one example I learned of how a person who was dismissed by many of her physicians as being a non-compliant morbidly obese patient found help and hope once a doctor took the time to listen to her and realized her unhealthy relationship with food was due to significant abuse issues in her past. And how this same clinician was able to connect this individual with an appropriate professional to begin to address the abuse issues and then (and only then) begin to work with the patient on her weight challenge.
I also heard from many who do not see the value and importance of relationship in healing. Here are some of those responses:
- "Relationship? Show me science!"
- "Relationship doesn't improve access, outcomes and lower costs."
- "That might work in the backwoods of Maine but has no place in the big city."
- "We have a budget to meet. We are focusing on reducing our cost-structure while increasing our volumes. We don't have time for relationship in healing."
- "Relationship is not fundable and sexy. Technology is fundable and sexy."
- "There is no evidence-base to support the importance of relationship in healing. The system requires evidence-based medicine for true advancement and improvement."
This second type of feedback got me thinking about one of the latest innovations in healthcare: the patient-centered medical home.
Patient-centered is a problematic term. I wonder if even in this new care model is the patient truly in the center or is a diagnosis in the center?
A physician is expected to establish a relationship with the patient, develop a trust where a patient will share their whole story, and actually and truly listen to the patient’s whole story in a ten minute visit. Without the whole story can a physician get to the correct diagnosis, along with the root-cause for the diagnosis, and then co-create with the patient the optimal care plan best suited for the individual patient?
A physician can know a diagnosis—and a standard of care based on that diagnosis, but is that really the same as knowing the patient and does this lead to optimal care and healing along with both short and long-term cost savings?
I don't believe real "patient-centered" care without relationship is actually possible. "Diagnosis-centered" care without relationship is absolutely possible, and unfortunately it happens every day and contributes to our health crisis.
So how do we reach those healthcare leaders who do not see relationship in the context of the healing process as a high priority?
By nature, I tend to go back to the basics when I am befuddled, so I turned to the Hippocratic Oath.
From the Hippocratic Oath (modern version):
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
Can a physician (or other healthcare provider) have warmth, sympathy and true understanding of a patient without having developed an authentic relationship with the patient? Can a physician understand "all related problems" without developing relationship, trust, and hearing the patient's whole story? Without this knowledge can a physician be optimally effective in his/her work?
Reaching those healthcare leaders who don’t value relationship is a challenge, to be sure. But it’s exactly why I’m lucky to work in quality improvement. We’re dedicated to identifying unusual challenges and finding effective solutions and I will continue in my efforts to bring relationship back into the healing model.