A patient-centered health care system

Published Jul 16, 2012 06:42pm

I was having a great discussion with a physician the other day in a social gathering until he stopped abruptly and asked me if I was a “lefty”. He works at a teaching hospital and has a busy private clinic. We had been discussing how the health status of people was determined by a complex interplay of physical, social, economic, cultural and environmental factors leading to the health status of a country or a community. References were made to the wealth of literature produced on these social determinants of health in the last three decades.

Our discussion had come to an abrupt end at the point in where I had argued that while achievements of modern medicine over the last century were impressive, the health system is failing to deliver even the most primary of the health services. I had suggested that this is primarily because of the hegemony of doctors over what goes in health care. It is this stifling control of doctor over health resources and systems that has become the problem. I had suggested involvement of stakeholders, most importantly the patient, in making decisions about how health systems work in the country. My good doctor had no stomach for this kind of ‘lefty’ talk and he moved on to another discussion in another group.

I have heard this argued in health professional and health user circles alike how advances in diagnostic procedures, non-invasive interventions, pharmaceuticals, and effective health promotion and disease prevention strategies have greatly improved the ability of health practitioners to diagnose, manage and treat numerous health conditions. But the reality of the matter is that, a majority of the people are still unserved and underserved in the public and private health sectors alike.

The major challenge confronting health systems today is the need to tip the balance away from health services that are overly biomedical oriented, disease focused, technology driven and doctor dominated. There is a clarion call to restore balance in health care, and the health system itself.

The health vision we need to support as consumers of health care systems and services is one which is people-centered in which individuals, families and communities are served by and are able to participate in trusted health systems that respond to their needs in humane and holistic ways.

Such a health system would be designed around stakeholder needs and would be centered around enabling individuals, families and communities to collaborate with health practitioners and health care organisations in the public, private and not-for-profit health sectors in driving improvements in the quality and responsiveness of health care.

Had our discussion continued on, I would have told the good doctor that unless we re-establish the core value of health care, which is health and well-being of all people as the central goal, we as health professional will be failing ourselves and the system. But he did not listen to me. I really hope he will be willing to talk again! I really need to argue with him for a more holistic and people-centered approach to health care, and a balanced consideration of the rights and needs as well as the responsibilities and capacities of all health constituents and stakeholders, most importantly the patient.

The overall vision for people-centered health care is one in which individuals, families and communities are served by and are able to participate in trusted health systems that respond to their needs in humane and holistic ways. The health system is designed around stakeholder needs and enables individuals, families and communities to collaborate with health practitioners and health care organisations in the public, private and not-for-profit health and related sectors in driving improvements in the quality and responsiveness of health care.

If my doctor friend is reading this I would like to underline for him what a people-centered health care may be like. Perhaps after reading this he can make up his mind to meet again and talk about it?

Such an approach towards health care is rooted in universally held values and principles which are enshrined in international law, such as human rights and dignity, nondiscrimination, participation and empowerment, access and equity, and a partnership of equals. It aims to achieve better outcomes for individuals, families, communities, health practitioners, health care organisations and health systems by promoting culture of care and communication, responsible, responsive and accountable services and institutions, providing affordable, accessible, safe, ethical, effective, evidence-based and holistic health care.

Whether or not we are able to move from a doctor-dominated to a people-centered approach is no more a choice – it is indeed an existentialist question both for the doctor and the consumers of health care systems whether in public or private sector.

Perhaps, it is time consumers were talking about rights-based approaches in health provision and consumption. A charter of patients’ rights might be good place to begin?


Ayyaz Kiani is a public health specialist. He heads Devnet – a network of development consultants. Based in Islamabad, he has travelled around the world and continues to do so to meet fellow travelers. He can be reached at ayyaz_kiani@hotmail.com.


The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.

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Comments (7) (Closed)


Boota Khan
Jul 16, 2012 11:13am
Now in order to be a patient centred doctor,you ought to have training and time for your patient. In primary care clinics where doctors are rushed to see 100s of patients in a day,they don't have enough time to ask for patient's ideas,expectations,his understanding of the problem and choice of treatment. Many a times beacuse of resource and financial constraints one cannot choose;rather he is obliged to accept whatever is available. Continuity of care is another important characteristic of patient centred care. However,we don't have any systems in palce where you can follow up a patient over his life time. Therefore,in order to have patient centred doctors and healthcare system,we will have to improve the systems and train the doctors as per modern trends in physician training.
Boota Khan
Jul 16, 2012 11:13am
I work in a patient centred health care system and manage physical health problems as well as mental health and social problems even. In order to have a patient centred system,you ought to have a proper primary health care system run by family physicians and allied health care professionals and need to have government backing and funding. Unfortunately,we do not have a proper health care system at all. We do have rudientary primary care system in the form of unstaffed/understaffed BHUs etc. Family physicians or GPs in semi-developed and developed countries are fully trained doctors who have undergone 3-5 years of postgraduate training in various specialities and have passed requiste national exams. They work has gatekeeps to health resources and contain health care expenditure on one hand and reduce burden on specialists in the hospitals on the other hand. They would manage all those conditions in community for which a patient would normally like to see a specialist in Pakistan. Patient centredness is hallmark of their training and even in their exams their patient centredness and communication skills are properly assessed.
Rafique Wassan
Aug 01, 2012 03:04pm
Good article to address the very important public health issue. but i want to learn how it is possible to advance the people-centered, human rights based approach to health care in the wake of market oriented, private centered and consumer oriented health system in Pak, the term 'Consumerism' highly dominates the health and education system in Pak, how it is possible to advance the values of equity, fairness and justice. As a student of medical anthropology, I would love to learn the answers of these questions making associated with the poor public healthcare system of Pakistan.
Umair Shafique
Jul 16, 2012 06:21pm
First of all the thing need to discussed with refrence of this post is the role of Doctor in the health system and the services delivered to a patient , he is the one who diagnoses and prescribe you the medicine. While prescribing the thing need to be focoused is the right medicine along with right dose in reference to the patient profile history . The problem here arises that the system is manipulated and became doctor dominated . I would like to qoute and example of a female here . Due to some reasons she was advised by her gynecologist to undergo D & C ( Dilation and curettage ) . after succesful D & C she has been prescribed the dose of muscle relaxant to reduce pain without focusing the right dose . This advancment made by the DOCTOR resulted in respiratory arrest due to diaphragm over relaxation . and at the end she died . Here i like to elaborate the point , if she is given the muscle relaxant the dose must be calculated and for that very important issue , Government is spending millions on Pharmacists who are been educated in government universities . These Pharmacist are liable to calculate the right dose in refrence to the previous history and the body chemistry of the patient , but as i stated before the system here is doctor dominant who is Prescribing the medicine by him self , the reason behind is the bribing pharmaceutical companies . Being a student and son of a Pharmaceutical company owner i would like to share some facts and figures here . When a medical representative markets his medical product that is prepared with a nominal cost . For example the medicine pack marked with 240 M.R.P is prepared with the cost of 40 pkr or maximum 50 pkr . The difrence between the cost and marked retail price is used to bribe the doctor who is the tool to compel the patient to buy that medicine by quoting that medicine in his prescription . More he prescribes more will he be paid . Even some times he is given offers like foreign trips or several advantages like cars , A.C for the room etc . The system is corrupted by these devils who are not letting the pharmacists to come in service who will snatch their that prescribing power of which they are being paid in millions . As the lack of professional and grade A officers other than doctors results the monopoly of doctors . While for this , the suffering is bared by the patient even resulting death of patients but who cares . The perfect health service system is like a chain cooperating system in which Doctor - Pharmacist - Nurses - dispenser work . > The authority of Doctor is limited till diagnosis ( he can suggest medicine ) but can't prescribe . he just diagnoses the disease and the certain pathogen that caused that disease along with symptoms. > The patient is then passed to Pharmacist where he check his previous drug history and allergies. He then prescribe him the medicine in reference to his body weight , age , sex , disease status . he council the patient with the quantity and dose . > The prescription is passed to the dispenser who dispense the medicine and give it to patient . The advantage to implement this system will result in following ways > Various deaths can be saved by administering the right dose > Our population is getting resistant to 4th generation medicine while in European countries and developed countries the population is still using 2nd generation of medicine. > The monopoly of doctors can be devastated by appointing another authority full class -A officers. > Medicine related precautions can be practiced .
aaa
Jul 16, 2012 06:56pm
Can you tell which country you work in?
Dr Sarosh
Jul 17, 2012 02:54pm
Of course a patient centred healthcare would be ideal and we can achieve that. But I differ from your opinion that policy matters and decisions are made by doctors. The core of the problem is that many policy matters are decided on political basis and when when these decisions are taken, neither a representation (a genuine one) of physicians is present nor of 'consumers'. There are many independent bodies including doctors and hospitals who are working with a patient-centered approach. People are being mobilized & trained to identify & solve the healthcare & related social problems of their communities.(I'd give u eg of The Indus Hosp, Khi & its Interactive Research Dept) But this needs to be done at government level and I believe Public health sector plays most important role in all this! Btw I think we're still better off than western & american doctors who just seem to talk to the computers instead of their patients and are totally dependant on lab investigations rather than clinical findings!
World News
Aug 14, 2012 11:38pm
Docters Must Have Gud training for the patient centred..Family Docters are well ahead in that. But they too need proper training and proper time