What is the Patient Centered revolution?

The ever-faithful rising and setting of the Sun in its daily course across the sky is one of the most beautiful and gloriously magnificent phenomena of nature. From the most hidden reaches of pre-history, humans have adored the sky-climbing Sun as a God of fire and life. The earliest scientists began by carefully recording for centuries its eternal path around the Earth. And even when the religious tone abated in favor of viewing the Sun as “the greater light to rule the day”, its stately movement through our skies kept it firmly the focus of intense scientific investigation.

So, when Nikołaj Kopernik (Copernicus) suggested that the most obvious fact about the Sun was an illusion - that the Sun does not go around the Earth, but the Earth revolves around the Sun - he was not believed. In fact, it was such a bizarre suggestion, easily refuted by anyone who cared to look out the window, that, despite his prestige as a great scholar and Cardinal of the Catholic Church, almost no one, outside a couple of young disciples and the astronomers and ecclesiastical think tanks in Rome, took him seriously for a very long time.

Of course, times have changed. And almost everyone nowadays believes Copernicus’ revolutionary notion that the Earth goes around the Sun idea is obviously true, an elementary fact of science, no matter how the sky looks.

As hospital based healthcare providers, we are invited to participate in a kind of “Copernican revolution” in how we think about our patients and the care they receive from us. This revolution is not proved by the laws of physics or astronomy, but it is based in logic and on sound principles of health and medicine. And it is not a new concept -- we are responding to a call that has been growing for many decades, more than a century. But we have not been taking it seriously, or not in the right way. And yet it is the foundation for rightly understanding our commitment to patient centered care.

Hospitals are not mere bystanders in the health history of the people we call “patients”, but they must learn to see themselves as existing for the other. First, then, let us review how the situation looks “out the window”.

There is no denying the “obvious fact” that hospitals are the centre of healthcare. Patients who get sick and need healthcare do wonder whether they will have to go to the hospital. They go first to their Primary Care physician, to find out. They may not have to go, but the hospital is always at the centre of gravity in whatever they do to get well. Or at least that is how it can seem to someone who works in a hospital.

After all, we only see patients who in fact did have to come to us. The other ones, who do not come to us, we are sure exist, but we don’t know much about them. Patients who don’t come to the hospital ... What kind of patient is that? They sound almost like “escapees”!

If we study a bit how healthcare is spread throughout our society, we soon learn that hospitals are not the only institutions that patients have access to. Besides the GPs mentioned already, there are various kinds of health-related clinics and offices. There are places that tend to diseases of the eyes, feet, elbows, and waistlines. There are labs to test almost everything. And there are dozens of “Institutes”, “Academies” and “Homes” that offer to do things that may or may not actually help a patient. Many of these may be found in a hospital. Some may have recently left a hospital setting. Others may be lobbying to be allowed in. A few are found both in hospitals and spread around the community. But what we see in the end is the immovably obvious “truth” that, ultimately, whatever the “exceptions”: patient care revolves around the hospital. Doesn’t that sort of “egotistical” statement make you feel uneasy?

Of course, hospitals are only places, where people and equipment are gathered together for the convenience of the patients. It is the expertise of healthcare providers that make Hospitals the centre of things. Patients don’t revolve around hospitals, they revolve around providers. When you put it like that - patients revolve around providers - the sense of creepiness really intensifies.

None of us, in our democratic culture that worships autonomy and equality, feels comfortable when one class of people revolves around another. And I put it this way to make you uncomfortable. It is precisely this kind of unequal situation that leads to revolutions. And, as health care workers and providers, you are in a position to make the revolution happen first. You can make it a conceptual revolution - one that affects attitudes and influences institutions without leading to protests, confrontations, and accusations.

We must begin with a reassessment of how we perceive our relationship, as providers, to those we serve with our knowledge and skills. By our own values and stated commitments, it is they who should be at the centre of our activities.