Consumer-centered care

Jun 5, 2009 5:37 PM

There is an interesting Q&A in the New York Times with Donald M. Berwick, M.D., a pediatrician and president of the Institute for Healthcare Improvement, on Patient-Centered medical care. The exchange illustrates that some of the health care reforms we need will never come from policy initiatives, but will only come when we change the health care culture to truly focus on patients.

In the piece, Dr. Berwick describes some basic problems with the system:

"Patients keep having to repeat their name because the system has no memory. We dress them in silly-looking gowns. We give them the food we make instead of the food they want… What is said is, ‘This is how we do things here,’ not ‘How would you like things done?’”

Good points. Smart health policy can help to a point. We favor comparative effectiveness research, for example, because it can help doctors and consumers make choices and lower costs. We work to provide consumers with choices between hospitals, and treatments, so they can work with their doctor to figure out the best course of action for their needs.

But some healthcare problems are so insidious that they get short shrift in the overall discussion about reform. Berwick’s example of hospital gowns is a perfect one. Hospital gowns are incredibly poorly designed. They work for doctors and nurses but are humiliating for patients. The gown destroys any sense of equality—the doctor has the white, authoritative coat on, while the patient has on a flimsy gown with their rear end sticking out. Who has the power here?

Gowns also provide no warmth, require a contortionist to tie/untie and are only available in one size—something either too big, too little, too short, or too long. Imagine if we had to make a decision about a car purchase in a refrigerator. So if we are really going to have shared decision-making could we agree both doctor and patient are reasonably clothed.

I always insisted on talking to patients in my office with their clothes on, and only switching to a gown when needed. I encouraged patients to use other, more comfortable clothes combinations if they preferred. Many men prefer keeping their shorts on, and it can make all the difference in the world. Likewise, there is often no good reason for women to remove everything. Most of the physical exam doesn’t focus on our private parts so why make an issue of them?

We’d like to hear from consumers and caregivers about other inequities in the patient-doctor relationship, and what you think should be done about them. And for all of you fashionistas—how about designing a better gown for doctors and hospitals to use?

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