The patient : A Vital Member of the Healthcare Team
By Michèle Sirois, host of the Ère Libre show on MAtv and collaborator at the Institut universitaire de gériatrie de Montréal (geriatric institute)
The time when doctors would prescribe a treatment, a procedure or medication without a thought to whether the patient agreed or not is on its way to being a thing of the past.
The medicine being taught today is in collaboration with a new member of the care team: the patient (1). Doctors, nurses and other healthcare professionals now consider the patient to be an active member of their team, given that they have a voice and unique knowledge of their own body.
Concept of patient as partner
On May 2, 2019, Dr. Paule Lebel(2) presented the patient-partner concept in a talk she gave at the Institut universitaire de gériatrie de Montréal.
What does this new vision of care involve? For decades, doctors didn’t see the people they were treating, but rather the disease. They would ignore the person’s history, preferences and life goals to focus solely on the medical problem. Doctors took a paternalistic approach. They knew what was good for the patient and would impose a treatment without the patient knowing why and what to expect.
Dr. Lebel said that unfortunately, this type of doctor-patient relationship still exists. Which is undoubtedly why more than 50% of patients in North America do not follow their doctor’s orders, or not to the letter. Starting in the 80s, medical students began to be taught to take the values and desires of the people they would be treating into consideration. That’s how the patient-centred approach came into being. All health professionals were working for the patient.
However, promoters of this approach noticed that they were missing some of the information they needed to treat the person properly. What if, instead of working for the patient, they worked with the patient? What if they took the time to listen? What if they combined their professional expertise with the experience and knowledge patients acquire over the course of an illness? And, most importantly, what if they considered what was important to patients in spite of their illness?
The culture underwent a major shift and the patient as partner approach began to emerge. The ultimate goal is now to help patients achieve their life plan no matter what stage their illness is in. In other words, to ask what is important to the patient at this moment. Is it travelling to France to meet his new granddaughter, despite his poorly controlled diabetes? Is it to continue living at home despite a heart problem? Is it deciding how to spend the last days of her life?
Dr. Lebel reminded us that plans evolve and change, right up until the end of our lives, and that healthcare professionals must adapt their treatments accordingly. Helping someone with a chronic illness achieve their goals requires everyone to collaborate. On one side, the professionals have a wealth of knowledge and experience acquired through practice. On the other side, the sick person has knowledge no one else possesses: experiential knowledge.
Who is better positioned than patients to recognize the signs and symptoms of their illness? To know what makes them feel better and what produces unwanted side effects? To know what will make life easier for them? This kind of knowledge isn’t acquired in classrooms, it’s developed over the course of an illness.
In the patient as partner approach, the patient and the professionals pool their knowledge. The patient is included in the discussions. He/She co-develops the treatment approach with the medical team. And the approach is always designed around the patient’s life plan. Dr. Lebel said that listening, trust and transparency are required from all team members during this process.
Power and responsibility
This power given to patients comes with greater responsibility. To be defined as a patient-partner, one needs to be curious and informed, among other things. For example, know which medications you are taking and why. Note if the solutions are working, be attentive to the signs and symptoms and notify the healthcare professionals of any issues.
And most importantly, want to be heard and involved in the decision-making.
Dr. Lebel said that past patients who have turned out to be good partners had immense capacity for self-determination that always surprised her. They better coped with the illness and felt that they had a greater sense of control over their lives.
More than a trend
Dr. Lebel assured us that this new approach is much more than just a trend. It’s the new way of providing care. As proof, all students studying the health fields at Université de Montréal receive training on the patient-partner relationship.
And who, among others, are teaching this class? Patients!
- The patient or his/her caregiver, if the patient cannot speak for himself/herself.
- Paule Lebel, MD, MSc, RCPSC, Specialist in public health and general preventive medicine; Senior Advisor, Centre of Excellence on Partnership with Patients and the Public (CEPPP); Clinical Associate Professor, Department of Family and Emergency Medicine, Université de Montréal; Medical Advisor, Direction régionale de santé publique de Montréal.