The healthcare environment today is different from that a century ago when care and compassion were about all that could be provided to patients in almost all instances. Technological advances in the last half century, the growth of other healthcare professions and specialization in Medicine have increased diagnostic and treatment options which have improved outcomes markedly.
However, it has also inadvertently led to the distancing of patients from their doctors and other healthcare professionals (“HCP”). This has resulted in patients and their families having to navigate their way through an increasingly complex healthcare system without guidance. There have also been perceived or actual exclusions from discussions on diagnosis and treatment leaving many patients and their families feeling that they were kept in the dark.
All patients expect to be treated with compassion, dignity and respect in a clean, safe and efficient environment.
The Picker Institute summarized the characteristics of healthcare from the patient’s perspective i.e. respect for the patient’s values, preferences, and expressed needs; coordinated and integrated care; clear, high-quality information and education for the patient and family; physical comfort, including pain management; emotional support and alleviation of fear and anxiety; involvement of family members and friends, as appropriate; continuity, including through care-site transitions; and access to care. (Source: Gerteis M, Edgman-Levitan S, Daley J, Delbanco T. Through the patient’s eyes. San Francisco: Jossey-Bass, 1993)
The routine engagement of patients and their families in healthcare decision making is challenging. The current barriers between patients, doctors and other HCPs have and need to be broken down.
Patients have to be educated on their role in decision making and be provided tools to help their understanding of the diagnostic and treatment options and, in particular, the consequences of their decisions. They have to be provided emotional support to enable them to make known their values and preferences, and not hesitate to ask questions of the attending doctors and other HCPs.
Doctors and other HCPs have to relinquish their paternalistic roles and become more effective partners of patients and their families in their decision-making.
There is an increasing global emphasis on value based and patient-centred models of healthcare. Quality healthcare is effective, safe and provided such that the patient has the best possible experience. The improvement of the patient’s experience is the focus for an increasing number of healthcare facilities and professionals.
Doyle et al, in their literature review, reported that there were “positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events.” (Source here)
From “What is the matter?” to “What matters to you?”
An ever-increasing number of doctors, other HCPs and healthcare facilities worldwide are resetting the focus of healthcare from “What is the matter” to “What matters to you”. Whilst the former is focused on the disease condition, the latter is focused on the person who is ill.
Conversations with patients about their lives build trust, develop empathy and understanding which provide the foundations of treatment paths that will lead to improved outcomes.
The concept of “What matters to you?” is simple yet profound. It is essential to the establishment of deep, personal engagements with patients and their families and provides doctors and other HCPs with an in-depth understanding of what really matters to them. This inevitably leads to the development of genuine patient-doctor and other HCP partnerships for shared decision-making in healthcare.
Since the introduction of the concept in 2012, its acceptance and practice has spread globally. There are reports of numerous examples of positive impacts when doctors and other HCPs inquire about what is really important to their patients. Individual care plans and patients’ relationships with their care providers have improved and, in some instances, health outcomes have also improved. Many care delivery processes have been reorganized to make them more user-friendly.
Jason Leitch, National Clinical Director of National Health Service (NHS) Scotland put it concisely: “There is nothing more powerful than taking a moment to connect on a personal level. We all know what that feels like, yet in health and social care we’re not always as good at it as we think we are. We like to classify by heart rates, drug lists and disease. What if we took a moment to get to know patients, families and carers in a more meaningful way and maybe even share something of ourselves too? My Dad cares about country music more than his macular degeneration and my Mum care more about tennis than her flu vaccination. That instant human connection matters more than anything else. ‘What Matters To You?’ conversations are deceptively simple, some would argue overly simple, but they are a start. Try it, you might be surprised what you learn.”
The “What matters to you?” day started in Norway in 2014 with the goal of encouraging and supporting meaningful conversations between those who provide healthcare with the recipients of healthcare. Since then, it has been taken up by an increasing number of countries, doctors, HCPs, healthcare facilities and patient advocacy organizations.
The “What matters to you?” question can be asked in different ways.
Patients have to ask themselves two questions i.e. Has a doctor and other HCPs ever asked you, “What matters to you?” Have you ever shared with a doctor and other HCPs what truly matters to you in your care?
Doctors and other HCPs are advised to encourage their colleagues, patients and their families to keep having these conversations every day of the year.
“It is more important to know what sort of person has a disease than to know what sort of disease a person has.” (Hippocrates 460-370 BC)
This is the personal opinion of the columnist. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organization the writer is associated with.
Dr Milton Lum is a past President of the Federation of Private Medical Practitioners Associations, Malaysia and the Malaysian Medical Association.
