Implementing person centred approaches
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4126 (Published 11 September 2017) Cite this as: BMJ 2017;358:j4126
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The perspective of a person centred approach is part of psychiatric work, after the closure of psychiatric hospitals and the opening of community mental health care centers.
Long-term hospitalization in psychiatric hospital was a standard response to personal and familiar diseases. The Italian reform of 1978 aimed at focusing personal rights and social role, with integrated “therapeutic work” of health and social systems, where patients and families are the center instead of the disease.
The “therapeutic work” needs to integrate not only psychiatrist and social workers but also the social milieu of patient’s daily life, in order to listen and promote patient’s possibilities, which cannot always be expressed in the therapeutic “setting”.
“Centered on patient” approach also avoids reducing therapeutic work to “accept or refuse” regular pharmacotherapy, helping the surroundings to support patients in a less compulsory and more aware acceptance of help, in order to develop a better role in the society and to develop also a better quality of life.
“Centered on patient” is also helping families to reduce the request of social control and delegation of patient to services, which also need to listen families and recognize them as an important part of mutual common work.
When a patient is conscious of his possibility to express and to be recognized as a person with rights, and when his social milieu knows how to help fmental health care in cooperative networks, compulsory need reduces and quality of life increases.
Competing interests: No competing interests
After debating among colleagues at the hospital's medical staff about the excellent article published by Ellen Nolte in The BMJ on implementing person centred approaches, we wanted to share our thoughts on the subject.
Person-centered care is a term frequently used in recent years in relation to care services for people in a situation of dependency, as in patients or users of health services.
There is a strong tendency to interpret it in different ways, depending on the people or the contexts. For some it means individualized attention and quality, for others it is a base of values. In any case, applying centered attention to the person implies recognizing the uniqueness of the person and fixing the gaze on their capacities in relation to that which makes them dependent, supporting their self-determination. For several decades it has been recognized as one of the axes that must be present in quality care; it is not always clear what it means and implies in terms of the concept and organization of care.
As a model of care, the idea emphasizes that care centered on the person is a professionalized model that seeks to care for people who can continue to have control in their environment, in their care and in their daily lives, developing their abilities and feeling good. It is a model that seeks to increase the quality of care from dimensions related to the quality of life.
People-centered care moves away from traditional care models where care is determined by uniform procedures derived from needs associated with disease classifications and degrees of dependency and by organizational constraints (what has sometimes been termed as models of focused care in services).
To make effective this model implies having an integral vision of people and recognition of its value and singularity and which looks at the capacities, rather than the deficits, and supports the self-determination of individuals. Direct care professionals, in addition to protecting people and attending to their diverse needs, relate to the knowledge of their life histories looking for opportunities and supports so that each person can develop their capacities, have control over their daily lives and consequently feel better.
Person Centered Care is a model that has an approach with a high capacity to improve the quality of services and guide good professional practice.
References
1. Santos Peña Moisés. Conferencia: La atención centrada en la persona en una red de servicios de salud. Simposio Responsabilidad del Hospital en la Red Integrada de Servicios de Salud. Convención GAL 2017. Cienfuegos, Cuba, marzo 2017. https://www.gal.sld.cu.
2. Rodríguez Rodríguez Teresa. Simposio: Humanización hospitalaria. Convención GAL 2017. Cienfuegos, Cuba, marzo 2017. https://www.gal.sld.cu.
3. Martínez Rodríguez Teresa et al. Modelo de atención centrada en la persona. Presentación de cuadernos práctico. Madrid, 2015. Informes Envejecimiento en red, nº 12.
4. Santos Peña Moisés. Simposio eficiencia de una red de servicios de salud. Simposio Responsabilidad del Hospital en la Red Integrada de Servicios de Salud. Convención GAL 2017. Cienfuegos, Cuba, marzo 2017. https://www.gal.sld.cu.
Competing interests: No competing interests
Re: Implementing person centred approaches
I read with interest the recent editorial on ‘Implementing Person Centred Approaches’ (BMJ 2017;358:j4126). I must first of all clearly state that I am neither an academic nor a health professional, I am a builder. A builder with a chronic disease (Ulcerative Colitis) that I have lived with for the last 5 or so years.
I am also aware, to an extent, of the pressures facing the NHS and the medical profession. Only what I see in the hospitals that I visit and hear through mainstream media channels, but enough to understand that to succeed the system needs to evolve and I think that the person centred care approach is a positive step.
It is encouraging to hear of building communication and relationships between healthcare professionals and the people receiving care as this can surely only serve to improve engagement and mutual understanding. (The healthcare professional’s understanding of the patient and the patient’s understanding of their condition/treatment).
I do however feel that in an organisational and system context (as well as a patient context) the article neglects to acknowledge an extremely valuable tool, that of the ability to share patient data. I refer not only to the appropriate and controlled sharing of patient data within and across relevant organisations which has its own merits, but also and importantly the sharing of patient data directly with the patient to which it relates.
During the years following my own diagnosis my relationship with my healthcare professionals (doctors, nurses and consultants) has quite suddenly and accidentally become more ‘patient centred’.
Two years ago I was at a stage in my understanding of my condition and treatment that was so limited it placed the entire weight of responsibility for my care on the doctors treating my condition. At that point in time I had lived with my diagnosis for three years and I was a passenger, along for the ride feeling I did not have a part to play.
Quite by chance I was then offered the opportunity to sign up for digital access to my records through ‘Patient Access’ by EMIS.
I have found that access to my medical data, including test results, consultation details, diagnosis history etc. has empowered me as a patient and given me a platform for the sort of communication with my healthcare professional that Person Centred Care appears to seek to achieve. I ask questions, discuss options for treatment and associated side effects, as well as assisting with the management of my regular scheduled treatments. I am able to feel a better level of care with less contact with the surgery. I can manage prescriptions and view test results without the need to take up time talking to the surgery staff. I can review treatment dates to ensure that my blood tests and treatments are scheduled appropriately without the stress of wondering when they are due. The access to EMIS has allowed me to take some ownership of my condition and work pro-actively with my various healthcare professionals in the management of my disease and its treatment both short and long term.
I have no doubt that I would not have had the confidence required to begin discussions with my doctors without the access to my records as a basis for communication.
I find the quarterly visits to my Consultant at hospital are also now far more useful. I am able to discuss the results of my GP surgery visits and test results and draw directly upon them at the consultation from my smartphone if required, adding depth to our discussions.
In short I am no longer a passenger, I am now very much part of the management team for the effective treatment of my condition and I am pleased to say that I am managing to remain in good health.
I understand that not everyone will have the capacity to use their data in this way but there are very many who will and I can see access to patient data being a very powerful tool indeed in achieving patient centred care.
Competing interests: No competing interests