Changing the patient-centered dialogue: Moving the conversation from why to how

Healthcare increasingly has been built around the wrong things.

We enhance electronic medical records when the records themselves are mainly built around maximizing revenue (not the patient).

We build new healthcare facilities when these buildings simply are another place for patients to come to (the services are not being taken to the patient).

And the list goes on.

And on.

Healthcare has become built around money and sickness. If you are in the healthcare business, you get paid when people are sick not when they are well. This is not a new fact and should not be a surprise to anyone. We react instead of proactively plan. Consider that:

“We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, depending on your definition, spend only about 1–3 percent of our $2 trillion in medical expenditures on public health.”

To begin to address some of these issues, our country (and government) decided to tackle healthcare through reform. But, in the words of our former CMS director, Dr. Don Berwick: “To get the care we need and want for everyone, without courting national bankruptcy, “reform” had better mean “changing care,” not just “covering care.” So far, it doesn’t.”

What’s somewhat ironic is that one of the best ways to change healthcare is to bring the patient back to the center. If the healthcare system were really created around the patient what would it look like? What does patient-centered care look like?

Would we have waiting rooms?

Would our time always need to be limited with our provider?

Would we always have to go somewhere to receive our care?

Would we own our healthcare data?

Would our preferences take priority?

While these questions may be difficult to answer, in some cases they are not (and actually happening).

From a British Journal of General Practice article looking at how well the US is putting patients at the center of care:

“Elevating the patient to prominence within health care is fraught with complications that often have more to do with the US’ historical healthcare fragmentation than the desire to have patients more involved. Primary care, as the largest platform of healthcare delivery in the US is currently being modified through the lens of the patient-centered medical home. This change has helped underscore the central role of the patient and community in health care.”

We are looking for ultimate transformation in healthcare, and while this transformation is achievable, it will not be easy. We know enough about why the patient should be at the center of healthcare, but do we know how to put the patient back to the center of care? The road map to reach this destination may not be that complicated; in fact, the road map may be to simply ask the patient.





Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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  • Spherical Phil


    Great post.
    The situation you describe of waiting “until we become ill” is not a
    medical system problem.

    This is a societal mind-set issue.

    political system, our education system, our financial systems, indeed the entire foundation of
    ‘modern’ systems is mechanistic and reductionist. This fosters a mind-set (worldview
    or foundational beliefs) that, if the machine (person, family, company, community
    or country) is not broke, don’t mess with it.

    This is not
    new news. We talk about the mechanistic nature of our systems when we stop for
    just a minute and reflect on what is going on. Then we get up and go back to
    our activities, where our jobs usually require us to work to fix broken parts
    in the machine.

    As you said,
    “it will not be easy” but if we don’t address the mind-set issue at
    the very start, as the very first activity, success will be elusive regardless
    of intent, effort and need.

    FYI – I
    like your “Ask, Listen, Learn, Act” On the back cover of my book
    Being Spherical – Reshaping Our Lives and Our World for the 21st Century, it
    says, “the authors explain why, in this dawning era of interconnection and
    interdependence, we require a dramatic transformation in the way we see, think and act.”