PCORACION’S MAR [15-03]:What is good patient care?

Medical Anecdotal Report
Indexing Title: PCORACION’S MAR [15-03]
Title: What is good patient care?
Date of Observation: January 2015
Tag: Good patient care is more than just having good rapport
Category: Professional/Ethical – Discovery

NARRATION:

I did an open cholecystectomy on a 68-year-old female with hydrops of the gallbladder. The patient was a chatty lady. I tried my best to give her my full attention every time I checked up on her. Even when the topic of the conversation has gone to various trivial things, I listened to her and indulge her when she told stories of when she was young. Her daughter-in-law, who was with her most of the time would always try to remind her that she shouldn’t be too talkative so that I could attend to other patients. I told them that I didn’t mind our little chats. She smilingly apologized but thanked me for being patient with her. The patient was eventually discharged and on her follow-up, she was, as usual, jolly and very eager to talk and tell me stories of whatever has preoccupied her. Her daughter came up to me and asked to talk with me in private. I obliged. She handed me a paper bag and said, “Maraming salamat po doktora sa pag-alaga sa nanay ko. Napakabait niyo po sa aking ina. Kinukwento niya po lagi na yung doktor niya po ay mabait at lagi po siya binibisita sa kwarto.” (Thank you doctor for taking care of my mother. You were very kind to her. She always tells us that her doctor was kind and always visited her in her room.) I told her that she didn’t have to give me anything but she insisted that I take it. I thanked her for the gesture.

INSIGHT:
(Physical, Psychosocial, Professional/Ethical)
(Discovery, Stimulus, Reinforcement)

How many times have we been told to always render good patient care? Countless it seems. What is good patient care? Is it gentle wound care? Is it explaining thoroughly in terms understandable to the patient his disease? Is it respecting the decision of the patient? Is it giving financial assistance when the patient lacks funds for his treatment?

Strictly speaking, patient care is/are service/s rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient. In this sense what we normally or routinely do is patient care. The extra effort and compassion we put into the service we render can therefore label our patient care as “good” because we get satisfied patients. However, if we look closer to what we do and our perception of good patient care, it seems that it only primarily involves the manner we talk or see our patients and how we approach them. Taking time to ponder on this, I have come across a term that I think would best encompass what our consultant mentors and our department has been teaching us.: “Patient-centered care”.

From the Institute on Medicine, it is defined as, “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” In the article “The Values and Value of Patient-Centered Care”, the points that are important for “Patient-centered care” are: 1.Patients are known as persons in context of their own social worlds, listened to, informed, respected and involved in their care and their wishes honored but not mindlessly enacted during their health care journey; 2.Training physicians to be more mindful, informative, and emphatic transforms their role from one characterized by authority to one that has the goals of partnership, solidarity, empathy and collaboration; 3.Infrastructural changes or technological advancements may move medical care to the 21st century but is not patient-centered care unless it strengthens the patient-clinician relationship, promotes communication about things that matter, helps patients know more about their health and facilitates their involvement in their own care; 4.The physician should invite the patient to participate; 5.The outcome of the management should not take a back seat and simply rely on having a good rapport with the patient.

For me, what we know as “good patient care” can be greatly improved and expanded to absorb the concept of “patient-centered care”. Nobody wants a scenario where a patient is happy with how we talk to them but their condition worsens when it can be treated. It is also not good when the patient or relatives heavily rely on us to make all the choices for it may backfire. Therefore rendering good patient care should not only be about establishing good patient rapport and practicing empathy and being compassionate. It should be able to integrate the patient-management process in order to provide effective and cost-efficient quality care where we not only emphasize on patient-physician relationship but also in attaining our goals of treatment. It should also actively involve the patient and relatives in decision-making from goals of treatment to the treatment plan.

ROJoson’s Notes (17jan4):

The other terms related to patient-centered care are patient or client experience and patient or client engagement.

Client or patient engagement refers to clients’ investment in or commitment to the hospital’s brand and product offerings.  It is based on the medical center’s ongoing ability to serve the clients’ needs and build relationship so they will continue to use medical center’s services and products. Characteristic of client engagement include client retention and loyalty, clients’ willingness to make an effort to do business with the medical center, and clients’ willingness to actively advocate for and recommend medical center’s brand and service and product offerings.

Client or patient engagement can also be in terms of commitment to a physician’s way of managing patients to the point that the patients like him very much.

Patient experience means the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care (from the Beryl Institute). Translating to client, client experience is the sum of all interactions, shaped by an organization’s culture, that influence client perceptions across the continuum of services.

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