Patient health and care – There is no 'I' in health or care

Speaking with the mother of a new nurse recently and listening to her relay her daughter's comments on her first nursing job proved to be a thought-provoking conversation. Interestingly, all of the daughter's comments started with or included the word "I" — "Mom I don't want to … I am feeling … I want to …" and so on. I conveyed to the mother that her daughter needs to remember patient care is not about her, it's about the patients.

By thinking about her own feelings, thoughts and needs, this nurse was pouring her energy and efforts into herself, as opposed to the care centered around the patient. I stated simply, "Those in healthcare are there for the patients, the patients are not there for them. If we stopped for a moment to view the actual words 'patient,' 'health' and 'care,' there is no 'I' in either 'health' or 'care,' only in the word 'patient.'"

Those in the healthcare industry tout the idea of prioritizing patients by using phrases such as "patient-centric" and "patient engagement," and yet current data trends suggest the contrary is happening. Instead, motivation based on self-interest continues to permeate care delivery.

Here are three trends in the healthcare industry that work against patient-centered care.

Direct-to-consumer advertising

For instance, advertising by telemedicine and pharmaceutical companies directly to the general public isn't necessarily in the public's best interest if the ads don't include the proper context or education. I've seen a TV advertisement for telemedicine care in which a young woman states, "I did not have a doctor. Using my iPad, I was able to get a doctor and — within three minutes — I had a prescription for an antibiotic." The commercial didn't address the ongoing increase of drug resistance and superbugs that results from the automatic prescribing of broad spectrum antibiotics, a topic about which many consumers know very little.

For care to be delivered with the focus on the proverbial "I" in the word "patient," the TV ad would need to explain that it is not feasible for a clinician to responsibly prescribe an antibiotic to a patient in less than five minutes, without a full medical history and culture. Most importantly, high-quality care should include establishing an informed plan of care and education for the patient on when an antibiotic is unnecessary and why.

More studies on antibiotics:
Antibiotics have long-term impacts on gut flora November 1, 2010, Society for General Microbiology
Antibiotics: Misuse puts you and others at risk, Mayo Clinic

Detached decision-making

Another trend impacting the focus on patient centric care is the distancing of decision-making and strategy from the actual care delivery level, and the diversion of resources to technology.

As hospital, physician and post-acute consolidations into large health systems continue, high patient volumes and convoluted organizational hierarchical levels make it increasingly challenging to ensure high-quality care for every individual. This includes the expansion of corporate and individual facility C-suites, with associated fiefdoms of information and competing initiatives, as resources are used to create top-heavy administrations in vertical silos.

Simultaneously, advancing technology related to EMRs has also created a shift away from the "I" in patient to the diversion of resources to supporting systems, and meaningful use reporting for reimbursements. A growing body of research and literature suggests the amount of time clinicians spend entering data and health systems spend analyzing that data, takes away from time that should be spent actually engaging individual patients.

Misguided population health efforts

Although population health may be a well-intentioned approach to care, it may not spell the best results for individual patients, depending on how the industry chooses to define the term.

I've written about the industry definition for population health previously. If the industry defines "population health" as the expansion of public health, the care won't be patient-centric. The focus ends up being on disease management — even though individuals are not just their diseases.

Another issue is how patient engagement is frequently discussed as a separate initiative from population health when it really should always be the "who," "how" and "why" within population health. The "who" includes patients, advocates, champions, educators, power of attorneys, care and health providers; the "how" involves working in partnership with each other; and the "why" is so individuals are empowered to take control of their own health for quality of life.

It's crucial that we remember the goal of healthcare is to improve the "health" and "care" of people, providing them with the best possible quality of life. If we remember that, we can shift the "I" focus back to the individual and patient.


Rose Rohloff is a 35+ year healthcare veteran with a background of nursing, business and information systems. She is a speaker for Healthcare we have forgotten someone – the consumer. Her focus is educating healthcare consumers to be empowered regarding their own health, removing information silos within health systems and expanding the traditional care continuum to a health maintenance continuum.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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