Integrative Care
Policy News

David Finer: Patient Focus Should be a Given

12 March, 2013 by David Finer

David_Finer_3044Is the health care system patient-centered? Hardly. Because by definition, if it were, the word itself would be superfluous, right? The concept exists because – as everyone who has ever been a patient or a “significant other” knows to their detriment – health care is a world unto itself, where as a patient, you sometimes feel like an uninvited guest.

Professionalism and professionalization involve a host of benefits: the introduction of standards of excellence, quality criteria, ethical conduct and so on, which increase the credibility of the group in question and the confidence and safety of the general public. In exchange, the professionalized group receives society’s stamp of approval and is awarded a large measure of self-regulation and independence.

The Downside of Autonomy
But there is a downside to autonomy. Professions develop their own rationalities, which are not necessarily in harmony with those of the so-called end users. Powerful, self-regulating subcultures such as medicine and the mass media tend to over time evolve mechanisms which primarily safeguard the interests and survival of Number One, i.e. the organization, and sub-optimize those of patients or readers/listeners/viewers, respectively.

In terms of the media, this might express itself as for example an institutionalized unwillingness to admit to mistakes and to promptly publish corrections. In medicine, the result can be unacceptable shortcomings in communication, empathic encountering, simple human concern and respect, the kind of things, which often do not even involve a price tag but are simply a question of basic human decency. Here, I C has previously reported on a Swedish initiatives towards establishing a Centre for altruism and compassion and reported from a conference on the importance of communication and dialogue in health care.

Health Care a Service Profession
Let me be frank. In my view, health care is – or should be – a service profession. Did I hear someone say, well what about journalism? I agree, so should journalism.

I hear teeth gnashing, breathing getting heavier, I am aware that a lot of people might not like hearing this. “Don’t start telling us what to do, we are underpaid and overworked, and are doing our very best!” But I can’t help it. The rationale of health care is to benefit patients and the lifeblood of journalism to put your public first. Meeting the wants and needs of these target groups is our most important (if far from only) remit, our raison d’etre, something we should be proud of and try and live up to.

That’s why the word patient-centeredness sounds more like an insult. Simply because it is there. Because it so shamelessly reveals the extent to which health care isn´t public-centered but instead so massively (de)formed by other agendas, ulterior priorities.

Disgruntled Swedish Patients
If the above arguments don’t convince you, you might want to consider some more hardcore ones. Such as those expressed in an external review on patient-centeredness in Swedish health care, commissioned by the Agency for Health Care Analysis [1].

”Patient-centeredness in Sweden’s health system – an external assessment and six steps for progress” is written by experienced health policy analysts Elizabeth Docteur and Angela Coulter. Their analysis is based on “The 2011 Commonwealth Fund International Health Policy Survey”, 2011, available online at, which in turn is partly based on a study of patient attitudes to health care in 11 comparable industrial countries.

According to the study, Swedish patients tended to be the least likely to report positive experiences of several aspects of health care, and did not even reach 50 percent’s patient satisfaction on three out of four ratings.

Swedish health care was seen as being least satisfactory in terms of patients´ potential to influence available treatment options (or their ”main objectives or priorities to manage their condition”, which the authors interpret as being the same thing).

Make Complements More Available!
Of course, this is where things get really interesting for us at I C, because the fact that patients are not offered complementary methods supported by evidence within conventional health care – on the same financial terms as regular care – seems to be one of the most obvious manifestations of placing patients in the periphery of their concerns, rather than in the middle.

In a truly integrative health care Sweden, methods with a promising evidence base would be made available within the framework of controlled comparative studies and via referral systems and collaboration with alternative practitioners outside of the system.

Increasingly, facts seem to indicate that active patients feel better, but there are less data on how increased patient involvement affects costs [2].

Although Swedish law in a general way obliges health-care providers to furnish patients with information on (allopathic) treatment options as well as e.g. side effects of medicines, patients often are not aware of what the legislation entails, according to the review. This lack may be due to paternalistic traditions in the caregiver-patient relationship, which are only slowly changing, the experts note. They also list cutback, renumeration incentives and administrative demands as well as the divided responsiblity between government and the county councils as pertinent problems.

Six points of advice for patient-centered care
Neither has the idea of truly shared patient-caregiver decision-making rooted itself in Sweden as yet, according to the experts. There are also shortcomings in terms of coordination and continuity, a holistic approach and the involvement of relatives/significant others.

The authors formulate six recommendations which can contribute to speeding up developments towards more patient-centered care in Sweden, i.a. to make sure that we abide bt the legislation to strenthen patient´s positions already in place, as well as making it possible – in reality – for patients to become collaborators in their own care, e.g. by providing support for them (us) to select caregivers, treatment methods and self-care options.

May the report become a wake-up call for everyone in a position to contribute towards the realization of health care provided on our own terms as patients and citizens.

David Finer

[1]. Elizabeth Docteur och Angela Coulter. Patientcentrering i svensk hälso- och sjukvård. En extern utvärdering och sex rekommendationer för förbättring (Patient-centeredness in Swedish health care. An external review and six recommendations for improvement). Myndigheten för vårdanalys (Agency for health care analysis). 2012.

[2]. Judith H. Hibbard och Jessica Greene. What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs. Health Aff February 2013 32:2207-214; doi:10.1377/hlthaff.2012.1061.


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