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A talk given on October 20, 2013, at the National Physician Alliance 2013 Annual Meeting, Washington, DC.
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Patient-Centered Care in a Doctor-Centered System
Zackary Berger, MD, PhD
Johns Hopkins General Internal Medicine
http://talkingtoyourdoctor.org
National Physicians Alliance 2013 Annual Meeting
Or: Searching for the Squircle
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What is patient-centered care?
What is patient-centered care?
• A philosophy– Patients are what matters most about any
health care encounter• An approach to quality improvement• A recipe for care delivery• An ethical requirement• A priority for health care reform
What are the characteristics of a doctor-centered system?
Doctors are…• At the center of every encounter• The most common subject of quality
improvement efforts• The essential nexus of care delivery• The engine of health care reform• A frequent object of ethical concern
How to square the circle? Some common proposals
• Place patients at the center!– Patients are people– People can make their own decisions
• Decentralize care!– Care should be available in multiple
formats, multiple settings– The promise of Big Data
• Centralize care!– Doctors: heads of patient-centered teams
Pursuing the Squircle: Doctor-Patient Partnership
• Not (just) patient-centered care– This is a laudable goal but does not adress
all questions• Not just shared decision making
– Not all encounters involve decisions– Not all patients wish to share in decisions
• Not all patients wish to participate in team-based care
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Optimizing the Relationship: A Research Agenda
• The PCP-patient relationship: characteristics, experiences, and outcomes– How do we define it?– Does it matter?– Does it mean better care?– Can we improve it?
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Optimizing the Relationship: A Clinical Agenda
• Improving and utilizing the PCP-patient relationship for improving outcomes– Can the PCP be preserved as part of
the medical home?– How can we clarify specialist and
generalist roles?– How relevant, or modifiable, is the
“gatekeeper” function?
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Optimizing the Relationship: An Advocacy Agenda
• Realigning our system and its incentives to promote the PCP-patient relationship– Changing the payment structure– Incentivizing primary care education– Equalizing involvement for all primary care
providers, e.g. NPs – Reshaping a culture of overuse– Redefining high quality care
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Zackary Berger, MD, PhD ([email protected])
http://talkingtoyourdoctor.org
Questions, comments, or ways to square the circle?
