Considering a Balanced Approach to “Training Doctors for Person-Centered Care”

To the Editor: The Commentary by Jeannine English1 advocates “honoring patients’ individuality” by shifting from “treating the patient” to “engaging the consumer.” Although well intentioned, this approach to patient-centered care may potentially lead to many unintended consequences. When a clinician judges that a treatment will do more harm than good, there is no obligation to provide that treatment even if the patient demands it. Thus, denying opioid treatment in pain clinics can be ethically justified.2 However, this decision may clash with the definition of patient-centered care that Ms. English presents. Another example is that thousands of parents have refused to vaccinate their children in the midst of a recent antivaccine movement. In this case, honoring the parental “individuality” means ignoring the potentially detrimental consequence of it on public health. In an extreme example of patient-centered care, Michael Jackson’s doctor was ultimately convicted of involuntary manslaughter after administering drugs in a way that was aimed at improving Michael Jackson’s satisfaction, yet ultimately led to the patient’s death.3 Ms. English also states, “Person-centered care is better for patients and for doctors,” but this needs substantiation. One way to focus on patient-centered care is to collect patient satisfaction data. However, Zgierska et al revealed that patient satisfaction survey utilization may promote job dissatisfaction and attrition among clinicians: “Seventy-eight percent [of participants] reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession.”4 Our concern is that, when too much emphasis is placed on a patient’s perception of satisfaction, rather than on science, we may create an unsupportive system for clinicians and ultimately turn away many promising students from the field itself. Treating a patient as a “customer” requires considering a patient’s request paramount in order to achieve satisfaction. However, patient-centered care should not be simply interpreted as patient satisfaction. The essence of patient-centered care requires shared decision making toward not only patient satisfaction but also good clinical outcomes. We should strive for patient-centered care, not patient-dictated care. Xiulu Ruan, MDAdjunct clinical associate professor of anesthesia, Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, Louisiana; [email protected] Rachel KayeUndergraduate, Department of Biochemistry, Bowdoin College, Brunswick, Maine. Praveen Narahari, MD, MSAssistant professor of psychiatry, Department of Psychiatry, University of South Alabama, Mobile, Alabama.