This post is a summary of Sue Robins’ talk at ACAC’s AGM in Red Deer on September 22, 2019.
What Is Patient Centred Care Anyhow?
Patient centred care is sadly an often misunderstood term. Simply put, patient centred care means doing things with patients, not to them or for them.
At its heart, chiropractic care includes trusting therapeutic relationships between patients and chiropractors. Positive health care experiences start with connections. Both patients and chiropractors need to know each other as people – not just roles – in order to trust one another.
Being human with patients is an essential part of patient centred care. This means engaging in chit-chat or asking questions to get to know patients beyond the issue that brings them to your office.
Remembering Your Why
Simon Sinek’s TED Talk Start with Why explains the importance of why you do what you do. Most people focus on what they do. How you do things is crucial. But the critical question for professionals is why you do what you do. Why did you choose to be a chiropractor? Why do you get up in the morning to go to work? Why are you treating this particular patient? The why question helps you refocus and remember your intention which leads you back to the meaning of your work. Your why likely brings you back to patients.
How Does It Feel To Be A Patient?
“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” -Susan Sontag
We all prefer to stay in the kingdom of the well, but eventually everybody crosses over to the kingdom of the sick, injured or disabled.
Becoming a patient can make one feel vulnerable or scared. Patients can be angry because they are grieving the loss of their healthy selves. Often patients present to you in pain or discomfort. Sometimes it takes a long time of looking for relief before patients finally find you, so they might show up frustrated too.
Understanding how patients feel is necessary to cultivate compassion through your words or actions and is an important cornerstone of patient centred care.
Why Practice Patient Centred Care
Patient centred care makes good business sense. If patients are happier, they will return for treatment. It is easier to have repeat patients than attract new ones, and satisfied patients talk to each other, which can help with building your reputation and word-of-mouth referrals.
Patients are likely to follow directions from clinicians they like and trust. Feeling listened to and understood is a part of building trust. If patients aren’t satisfied with their experience, then trust will be eroded. It is extremely difficult to get trust back once it has been broken.
There is a moral imperative associated with patient centred care. Are you just doing things right in your practice? Or are you doing the right thing?
The Foundations of Patient Centred Care
There are four main elements of patient centred care: respect, dignity, information sharing and collaboration. These can be considered soft skills, but soft skills are often the hardest skills because they involve relationships with human beings. Humans are all different, so there is not one formula that works with every single patient. However, respect is a good place to start with everybody.
In health care, respect looks like smiling, eye contact, introducing yourself, telling patients what you are about to do, not appearing rushed even if you are rushed and using people’s chosen names instead of nicknames. Giving time for questions is crucial to respect. This can be done by reframing questions. For instance, ask ‘What questions do you have’ and waiting for a response instead of asking ‘Do you have any questions’ as you are hurrying out the door.
Dignity is about privacy. This includes health information privacy. This can be as basic as ensuring that people can’t overhear receptionists talk about other patients in the waiting room. Privacy is about being vigilant that patients retain as much dignity as possible during appointments with their clothing and how they are positioned.
Dignity is also about treating patients like full human beings, not just a diagnosis or problem. Importantly, dignity is about giving patients as much flexibility and choice as possible. Letting people make their own decisions gives them agency and allows them to retain some control over their lives.
Information sharing is communication. It includes patients fully understanding the benefits and risks for treatment and having the right information shared with other members of the patient’s health care team.
For patient education materials, considering clean graphic design, translating materials into other languages and communicating in plain language to make sure what you are trying to communicate is understood.
Health literacy underpins all information sharing. It is the responsibility of the health professional to make sure they have communicated effectively with patients. As Da Vinci said, simplicity is the ultimate sophistication. This does not mean ‘dumbing down’ language – it is a skill to make sure complicated health information is shared in an understandable way.
Collaboration is the final element of patient centred care. It includes setting goals together for shared decision making. Believing that patients are experts of their own bodies is the best start to collaboration. True partnerships happen when two bodies of knowledge come together – your chiropractic knowledge and the patients’ own expertise.
I often get asked, “What do patients want?” The answer is, “It depends.” It depends because every single patient is different. The key is to ask individual patients what they want.
My challenge to you is to think about ways you can enhance patient-centred care in your practice. This could include improvements like designing your waiting room so it is more patient-friendly or giving your reception staff feedback about their customer service skills.
A trusting therapeutic relationship in chiropractic care is built on the foundation of respect, dignity, information sharing and collaboration. These are worthy investments to guarantee a positive patient centred care approach which benefits everybody – patients, staff and chiropractors alike.
About the author
Sue Robins is an author and health care advocate. She was the family centred care consultant at the Stollery Children’s Hospital for 4 years and was recently the family engagement advisor at the B.C. Children’s Hospital.
Sue’s writing has been widely published and includes articles in the Canadian Medical Association Journal, The New York Times and The Globe and Mail.
Her first book Bird’s Eye View: Stories of a life lived in health care will be published in November 2019. Sue is a senior partner in Bird Communications, a health communications company.