Achieving patient-centered care is difficult, yet essential; paternalism is, of course, out.

 The editorial, "Patient-Centered Care; What Is the Best Measuring Stick?" by Drs. Lin and Dudley (Archives of Internal Medicine), begins with an apropos quote of Sir William Osler: "The good physician treats the disease; the great physician treats the patient who has the disease."

It continues by establishing a fundamental point of contention in the current health care debate: our care is fractionalized, oftentimes, uncoordinated and thereby compromised.  Consequently, patients are inadequately involved in decision-making; at the very least, they may be uninformed.  "Poor-quality decision making can lead to lower patient satisfaction with care, lower adherence to treatment plans, and worse quality of life.^8-9 Substantial physician barriers to high-quality, patient-centered decision making include lack of time for detailed discussions during clinical encounters, lack of effective communication skills, and misalignment of financial incentives."¹⁰

Lin GA, Dudley RA. "Patient-Centered Care; What Is the Best Measuring Stick?" Arch Intern Med. 2009;169(17):1551-1553.

8. Greenfield S, Kaplan S, Ware JE Jr. "Expanding patient involvement in care: effects on patient outcomes." Ann Intern Med. 1985;102(4):520-528.  FREE FULL TEXT

9. Joos SK, Hickam DH, Gordon GH, Baker LH. "Effects of a physician communication intervention on patient care outcomes." J Gen Intern Med.1996;11(3):147-155. ISI | PUBMED

10. Holmes-Rovner M, Valade D, Orlowski C, Draus C, Nabozny-Valerio B, Keiser S. "Implementing shared decision-making in routine practice: barriers and opportunities. Health Expect. 2000;3(3):182-191. FULL TEXT | PUBMED

The entire article is a good, brief and important read.  But, before leaving it,  there's one additional point they make about the processes as opposed to the outcomes of healthcare.  In keeping with Sir William Osler—only focusing on outcomes is too coarse an objective. In one study, for example, the authors mention that a decision aid did not improve the "outcomes" in type II diabetics as measured by adherence or HbA_1clevels; nevertheless, it did engage patients in decision-making, especially about their medications and, clearly, that is vital (and reimbursable).  From the managerial point of view, while there was a large Hawthorne effect, patients were helped.

Mullan RJ, Montori VM, Shah ND; et al. "The Diabetes Mellitus Medication Choice decision aid: a randomized trial." Arch Intern Med.  2009;169(17):1560-1568  FREE FULL TEXT 

What is more important--the destination or the journey?

[Note: This article was posted to MDNG.com where it is entitled, "Healthcare Reform," Friday, October 2, 2009]