Why should the patient be at the centre?

It seems logical to organise healthcare around the needs of the patient. After all, it is the patient who needs the care, and it is the patient who is – or who should be – at the centre of any decisions that are taken about treatment.

For many years, however, this has not been the case. Doctors have often been seen as intellectually superior to their patients and as a result very little explanation about treatment has been seen to be necessary. Patients often believe that the health care workers know best, so they are reluctant to ask questions about different treatment options or to get a second opinion.

This perception has gradually been changing, and since the turn of the century, the concept of a patient centred approach has begun to gain momentum. What was once a radical concept has been pushed into the mainstream, and patient-centeredness is now being seen as an essential foundation for quality care and patient safety in many countries around the world.

That is the theory, at least. In South Africa there are many barriers to a true patient centred approach. The shortage of specialist staff means that healthcare workers and doctors may not have time to find out their patients’ needs. There may not even be time to find out whether the patient understands their diagnosis and the recommended course of treatment. Cultural issues and language can also be barriers to true patient centeredness.

We talked about this in our blog of September 1  where we said:

C = Current Care: Right now, we can only say the standard of current care is, well… careless. And, to quote wise old Dr Seuss: “Unless someone like you cares a whole awful lot, Nothing is going to get better. It’s not.” Let’s get caring: actively!

So, what would we like to see as an ideal patient-centered model in South Africa for people with breast cancer?

  • We want providers to partner with patients and their families to find out what the patient needs. It is their body and their life so empathy and humanity must be at the fore. Each person with breast cancer’s preferences for care are important.
  • We want health care staff to be supported so that they can focus on their patients. Providers need to feel that they are cared for so that they have the strength to give excellent care to others.
  • We know that the patients are not always able to accurately assess the quality of their care, but we want an environment where their questions are heard, and the reasons for a particular treatment protocol are clearly communicated. Patient centred care does not replace excellent medicine, it complements it.
  • Patients who are not at the centre of their care often feel dehumanised and fearful. We want clear communication between the healthcare professionals and the patients. Provision must be made in specialist breast clinics for different language needs.
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