“Collaborative care” is preferable to “patient centred care”
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2926 (Published 26 May 2016) Cite this as: BMJ 2016;353:i2926
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Aronson points out several advantages of “collaborative care” as a general model (1). The politically correct alternative “patient-centred care” hardly applies, at least in its literal meaning, where patients are unconscious, otherwise incompetent, or subject to compulsory treatment of mental illness. In these cases, we are obliged to act in what we judge to be patients' best interests, ideally informed by prior preferences or input from next of kin (2).
A related problem occurs when patients request inappropriate investigations or treatments (3), often due to misunderstanding and/or health anxiety. Such requests can be stimulated by direct to consumer advertising (DTCA) of diagnostic tests or prescription pharmaceuticals, notably in certain jurisdictions (4). Collaborative care, emphasising best evidence, is a particularly apt unifying principle in cases where patient preferences are either unavailable, unreliable, or inappropriate.
1. Aronson J. “Collaborative care” is preferable to “patient centred care”. BMJ. 2016;353:i2926.
2. Duggal R, Menkes DB. Evidence-based medicine in practice. Int J Clin Pract. 2011;65:639-44.
3. McCaffery KJ, Jansen J, Scherer LD, Thornton H, Hersch J, Carter SM, et al. Walking the tightrope: communicating overdiagnosis in modern healthcare. BMJ 2016;352:i348.
4. Every-Palmer S, Duggal R, Menkes DB. Direct-to-consumer advertising of prescription medication in New Zealand. NZ Med J. 2014;127:102-10.
Competing interests: No competing interests
There are always some advantages and disadvantages associated with each system of care. In patient centred care, optimum care might be missed out due to interference from patient himself due to lack of knowledge and awareness. Collaborative care may disregard patients feeling while planning, administering and managing a medical problem. This may lead to patient dissatisfaction even though the treatment administered would be standard. Ideally there should be balance between collaborative care and patient centred cared depending upon individual cases. Thus under treatment, over treatment and patient dissatisfaction will be avoided and balanced type of care is administered to the patients.
Competing interests: No competing interests
In this article, Aronson is describing something I often write about in connection with end-of-life [but from the perspective of a family carer or patient].
I can only concisely make two points. The first is that although there can be conflicts between laws, those conflicts are usually less significant than the conflicts which arise when people 'work from ethics'. The second, is that 'duty of care' has logically been removed from the English law covering capacitous adults (1). It isn't necessarily incompatible to believe that a doctor's objectives should be guided by 'a desire to 'care'' while the law supports patient autonomy: it only becomes problematic, if a doctor seeks to use 'the desire to care' to thwart the decision-making autonomy of the patient.
Competing interests: No competing interests
Re: “Collaborative care” is preferable to “patient centred care”
Thank you for this insightful piece which eloquently describes the competing interests that exist in many of our clinical encounters. Involving patients in their care is to be encouraged and this has formed the basis of recently published work developing the patient perspective as part of clinician-driven medication review http://ejhp.bmj.com/content/early/2015/12/23/ejhpharm-2015-000762.
The term "collaborative care" as it relates to clinical consultations is to be encouraged, It balances clinician knowledge and experience with patient knowledge, preferences and values to optimise the patient experience in receiving safe, effective care.
Competing interests: No competing interests