Towards a global definition of patient centred care

Editor,
Stewart's summary of and enthusiasm for a patient centred approach is most
welcome. I believe that one additional feature of this approach should be
added - that it acknowledges the reality of patients accepting or
rejecting our advice or treatment. Clinicians working in the field of
alcohol and other drug (A&OD) problems, particularly those working in
the harm reduction model, have known this for years. The work of W R
Miller, for example, has shown that the more confrontational (ie, non
empathic, non patient centred) the clinician, the poorer the outcome.
Previously, poor outcomes were taken as a sign of the patient's denial or
unwillingness to change - now most clinicians (A&OD, at least) accept
that these problems usually represent therapist failure. The increasing
evidence that it is not just those naughty alcohol and drug users, but
indeed most humans, who do not always "comply" with our treatments, must
surely make us more keen to enter our patients world and mind set as a
clinical priority, at least if we wish to achieve good health outcomes.
Stewart's point that some "may not prefer a patient centred approach"
constitutes a false objection is most important, since any clinician who
rigidly adheres to any model as taught is, by definition, model centred,
not patient centred!
Working in A&OD, we often meet people who are very sick, and who are
occasionally dead by violence, overdose or organ failure over the ensuing
days or weeks. With respect to outcomes, it is a discipline as serious as
any other. But we do not delude ourselves that we can do much more than
attempt to briefly enter another person's world and possibly help make
some positive changes if they wish. I strongly suggest that all health
training and undergraduate programs incorporate significant exposure to
the management of A&OD problems, as a means to understand the person
centred approach.