Even though the term “patient-centered care” was first employed in the 1988 Picker/Commonwealth Program (1), the principle itself goes back to the ancient Greek school of Cos, which paid special attention to the particulars of each patient (2). Since, various approaches seeking to centralize patients in healthcare have arisen and, today, the majority of healthcare systems are trying to adopt this approach, hoping that it would improve health outcomes as numerous studies have observed.
One of the pillars of healthcare delivery is effective doctor-patient communication and the patient-centered approach was based on this belief. In general, the strength of the doctor-patient relationship is determined by the doctor, whose willingness and capacity to partake in effective communication reflects competence. The three main goals of effective communication comprise the strengthening the doctor-patient relationship, efficient exchange of information and inclusion of the patients and their families in the decision-making process.
Patients reporting communication with doctors as “good” were more likely to share information for a more accurate diagnosis and follow advice and recommended treatment. Additionally, the sense of control acquired through improved communication with doctors was shown to be associated to tolerance to pain, recovery, daily functioning and even lead to decreased tumor growth among cancer patients. Furthermore, improved psychological adjustments as well as mental health were also reported together with a declining length of hospital stay and the consequent reduction of clinical cost.
Not only does a good communication between both parties lead to improved health outcomes, it also results in increased patient satisfaction, who in-turn become less likely to file complaints, as well as an enhanced doctor satisfaction with the job, a decline in work-related stress and less burnout (3).
A relevant example from the Egyptian reproductive health services context – to some extent – underlines the aforementioned observation. Data acquired during a study by Abdel-Tawab and Roter from 2002 on feasibility, acceptability and effectiveness of a client-centered communication model in selected family planning clinics showed that even though the consultations, that were characterized as client-centered, extended by only one minute, they were correlated to a three-fold increase in the probability of client satisfaction and family planning method continuation at 7 months. One indicator to client satisfaction was described as the high amount of positive statements by the physicians, while directive instructions and increased disagreement was predictive of family planning method discontinuation (4).
This study implies that, just like in developed countries, exposure to a client- or patient-centered approach in communication is likely to lead to enhanced medical outcomes than those associated with a physician-centered model of communication. It is evident that the patient-centered approach has gained worldwide momentum, however, some challenges particularly prevalent in Egypt might hinder its adoption in the country, which include a poor education and health literacy, challenges in finding culturally appropriate educational material and an overall ailing public health system that includes underpaid medical staff.
References
Shaller, D. Patient-Centered Care: What Does it Take? The Commonwealth Fund, October, 2007.
Stewart M, Brown JB, Donner A, et al. The impact of patientcentered care on outcomes. J Fam Pract. 2000;49(9):796–804.
Fong et al., 2010; Fong, J. Ha, N. Longnecker. Doctor-patient communication: a review. Spring, 10 (2010), pp. 38–43.