RECONCILING PATIENT-CENTERED CARE, EVIDENCE-BASED PRACTICE, AND INTEGRATIVE MEDICINE
Nov. 8-9, 2012, Hilton Old Town Alexandria, Alexandria, Virginia
What does it mean to provide care that is truly centered on the needs of patients? Samueli Institute investigated this question at a national symposium in Virginia Nov 8-9, 2012. More than 150 participants engaged in two days of intensive and spirited discussion of the successes and failures of the American health care system, specifically with respect to patient preferences, cultures, fears, hopes, and dreams, all within the context of family and community. Symposium participants included representatives of patient groups and health advocacy groups, as well as government leaders, military health care providers, health policy analysts, clinicians, and researchers from around the country.
The Symposium focused on four areas of patient-centered care: practice, educating practitioners, health-care systems, and research. Within each topic, participants identified barriers to patient-centered care and developed plans of action to address them. Detailed reports of the presentations and roundtable discussions are being prepared. Following are some highlights:
The most important service that doctors, nurses, and other clinicians can provide to patients is the gift of time and attention. Even in a 15-minute appointment clinicians can reveal their own humanity and connect with the humanity of their patients. The voice of the patient is saying, simply, “Listen to me; truly see and hear me; and let me see and connect with something true within you.” In order to achieve this connection, clinicians must become aware of their own needs and preferences, and take steps to care for themselves and to develop the art as well as the science of healing. They can be trained to do this through:
The education of health care professionals needs to use a common language that reflects patient-centeredness, and involve both internal reflection and experiential learning. The emphasis should be more on promoting health and wellness (“salutogenesis”) than on the diagnosis and treatment of disease processes (pathogenesis). Education should include not only the development of key competencies but also the building of relationship and behavior skills. It should include families and patients at all levels. All of this has to happen within transformations of:
Health Care Systems
What if we developed a Health Promotion Industrial Complex? To provide true patient-centered care, the health care system and its payers need to transform their focus. There is a sense of urgency: During the two days of the conference, for example, 36 veterans around the U.S. committed suicide. The White House should be pushed to create a summit to address the health of the nation, including lifestyle, nutrition, financial and political support of health promotion, and the connection of the national health to national defense and economic health. All of the above changes in practice, education, and systems, should be supported by strong evidence-based research:
The challenges of developing a patient-centered research agenda include:
The development of ways to measure meaningful patient centered results; to improve health literacy to help patients and families communicate with providers; and to train patient advocates to be effective and to understand both the terminology and the environment of research. There also needs to be a stronger focus on the development of translational tools for integrative research. This requires community input and the development of sampling science that accurately represents demographics.
Photos from the Patients at the Crossroads Symposium are available on the Samueli Institute’s Facebook page.