What health care philosophy is best? You decide

Generations of patients have heard the old saying, “the doctor knows best”, and we swallowed it like cough syrup and castor oil. But times are changing. In this era of health care system pressures, patient needs, preferences and values are becoming increasingly important for achieving good health outcomes. I believe this is at the root of some of the new models for doctor-patient care – models that involve communication, the foundation on which a contemporary relationship with doctors is built.

From our own experience with different rheumatologists over the years, I think the best patient-doctor match comes from a cooperative partnership, mutual respect and the right blend of personalities.

What philosophy works best for you? Let’s take a look at two approaches from each end of the continuum.

Provider-Centred Approach: In this scenario, the doctor makes most of the decisions with little or no involvement from the patient. The patient is supposed to follow the doctor’s orders and not ask too many questions - the doctor is the expert after all. Unfortunately, in this model, if there is no buy-in from the patient, the results can be moderate to disastrous.

Patient-Centred Approach: An informed, knowledgeable patient asks questions of their healthcare provider and communicates their needs and preferences to the doctor. The patient is confident and empowered; they know their body and know their treatment options. A good working relationship and dialogue is fostered between the patient and doctor. Treatment decision-making on medications, physiotherapy and other aspects of care is shared.

Of course, these are the extremes. There are many different models in between, one being the Community Health Centre model, where the physician works within a multi-disciplinary team. The patient first presents to the Nurse Practitioner, who then decides which health professional is best for the patient at that time. Maybe it’s the social worker or physiotherapist. Perhaps the physician isn’t needed at all at this visit.

Patients have a right and responsibility to participate, to their level of ability and preference, as a partner in making health care decisions that affect their lives. The Canadian Arthritis Bill of Rights outlines key patient responsibilities for health self-management. People with arthritis have the responsibility to:

Pursue healthy lifestyles Become knowledgeable about their arthritis treatment plans Actively participate in decisions about their arthritis care; and Cooperate fully with mutually accepted courses of treatment Barriers exist to achieving the patient-centred approach. Some doctors are leery about having a patient become too much of an expert. There is so much false information circulating on the Internet and their medical training causes them to be skeptical. Limited time to talk with a doctor during regular medical appointments is also an issue. This just reinforces the need for a prepared, informed patient and team based models of care. All the responsibility doesn’t have to lie with the physician.

A patient-physician partnership in health care decision-making yields the best outcomes. The results of a mismatch between patient and physician can be tragic. Patients may disregard their doctor’s expert advice, disregard the perceived agreed upon treatment plan and worse still, not tell their physician that they have opted out.