The BMJ Today: Patient centered care

jose_merinoIn May 2013 in The BMJ, a group of patients, clinicians, and editors called for a patient revolution, which would empower patients to “work in partnership . . . [with their doctors to] improve healthcare and challenge deeply ingrained practices and behaviors.” To further foster the revolution, The BMJ has published several articles that put the spotlight on patient centered care.

This initiative—developed as a partnership between the journal, clinicians, patient advocates, and patients—reflects The BMJ’s commitment to patient partnership. The series highlights challenges, opportunities, and successes on the road to the development of truly patient centered care. I will briefly mention some of these, and I expect that in the coming days other blogs will address additional issues:

The focus on acute care in most health systems does not lend itself to the kind of coordinated, comprehensive care that is required to deliver patient centered care in long term conditions. But organizations and several governments have found ways to engage patients to determine the goals of treatment, engage them in the provision of care, and design better healthcare services.

Patients are gaining autonomy, learning about their condition, and assuming a greater role in their care. Clinicians have to welcome these empowered patients as partners and recognize them as the most important member of the team.

Patient reported outcome measures (PROMs) are slowly making their way from the realm of researchers to the clinic, and will lead to better care because they focus on the patient’s experience of illness. Programs that successfully implement PROMs in routine care have been developed in several countries and they have led to better patient outcomes.

Technology has been a powerful tool for the development of patient centered care. Sharing clinical notes with patients—something that is possible owing to the widespread implementation of electronic medical records (EMR)—can help patients understand the thought process of the clinician, may promote greater compliance with treatment prescriptions, and encourage greater collaboration with clinicians. It is also one of the elements of a patient centered practice. In several health systems in the US, patients have access to the notes of their physicians and the practice is being adopted in the UK. But to achieve the full potential of shared notes, EMRs have to evolve and become more patient-centric.

Anyone with an internet connection can get information—true and erroneous—about a disease. Social media and online communities allow patients to exchange information and ideas, and are a source of emotional support. Researchers are also using the internet to develop, test, and implement tools and instruments that can be used for shared decision making.

Many of the articles in the series emphasize the part that patients play in clinical decision making. But as Anita Jain reminds us in her essay on patient engagement, patients can also work together to achieve broader societal changes.

The articles just published in The BMJ illustrate the value of patient engagement in healthcare. They will hopefully generate discussion and foster actions to improve healthcare.

José G. Merino, US clinical research editor, The BMJ.