Editor’s letter

Dear Colleagues and Friends.

A new year! I will start with gratitude for your support for our readers as well as our reviewers. Your ongoing support is revolutionizing the field of patient experience by bringing in more research and best practices.

Just last week I received an email saying that one of the best practices of another healthcare system was that it moved from being physician-centric to patient-centric. I felt a pang of disappointment in my chest—mainly because this didn’t feel revolutionary. We have been talking about patient-centeredness for a very long time. Then a little bit of frustration hit me. Why are we polarizing healthcare to either focus on its employees or its patients? We must advance the dialogue.

The term “patient-centeredness” rose to fame in a 2001 IOM report (1). The report talked about patient-centeredness as an important component for change and this meant aligning patient preferences with their care. Other well-meaning, popular terms like “shared decision-making” and “patient engagement” have also emerged. At the same time, calls for addressing burnout in healthcare have increased and many groups are working hard at improving the burden of the system on clinicians. Both are real, valid, and needed.

The true opportunity, however, exists in striving for relationship-centered care (RCC). Many of you have heard me use this term. Beach and Inui wrote a sentinel paper, which should be a required read for all patient experience professionals; it reviews the four components of RCC, which especially have more relevance today (2).

Rather than review them here, let me give you an example. A 54 year old male with multiple sclerosis with moderate lesion burden in his brain and cord has chronic pain. He has tried many anti-epileptics and medications to ease his pain, but the only thing that works for him is Percocet, which he received from his prior neurologist. He has just recently become my patient and he is requesting multiple refills for Percocet. I am not comfortable prescribing the dose and medication he has requested. But, if I am practicing patient-centeredness, should I give it to him since it’s “his preference”? Or if I am feeling doctor-centered, should I have a conversation with him about a more medically appropriate choice and not fulfill the request? What happens to patient satisfaction scores if I set boundaries and limits that run contrary to what the patient wants? There is, of course, no answer. The truth lies in the nuances all clinicians face daily. We try to build a relationship to understand the patient and their needs and perspective, while also maintaining integrity in our practice and set effective boundaries. Both parties are likely to suffer, or already are, and suffering do not discriminate.

So let’s stop this binary patient-centered or doctor-centered dialogue and focus on what both sides value; mutually beneficial relationships with one another grounded in trust and compassion. Leaving one party out undermines their value.

As the final piece from Richard Bruce Hovey in this edition highlights, we are “occasionally a patient, always a human.” At our best we must be person-centered, and relationship-centered whenever possible.

Adrienne Boissy, MD, MA Editor-in-Chief