NEPA Vital Signs - Summer Fall 2017 - 17

S U M M E R / F A L L 2 017

Feature

of respect is culturally sensitive, and
with the increasing diversity of patient
populations, cultural sensitivity is
critical to addressing individual medical needs. The buzzwords "cultural
competency" encompass this aspect of
patient-centered medicine.

Physicians who make patients the center of their
medical practices are empathic listeners, careful
observers and caring providers.

research, prior recommendations have
been revised or completely discredited.
Overdiagnosis and overtreatment of
breast cancer, in addition to other risks
associated with mammography, have led
to new screening recommendations.
Clinicians are now advised to customize
mammogram recommendations based
on the unique clinical presentations of
individual patients (factors such as life
expectancy, age and family history) and
a discussion of the risks and benefits
of screening (Myers). The research
community's recent evidence-based
"Evidence-based medicine" are other conclusions that mammogram recomrecent buzzwords in the evolving conver- mendations should be customized is
sation of medicine. An evidence-based patient-centered medicine.
approach to medicine, built on clinical
Engaging a patient as a member
research and epidemiology, calls upon all
physicians to assess their clinical habits of his or her own treatment team is
and methods of treatment to ensure empowering. This approach facilitates
that the way they care for patients is better patient outcomes by eliciting
fundamentally founded on the empirical more complete medical histories, by
evidence of science. Why all the trou- considering the patient's desires in a
ble? The answer is the patient. Patients shared decision-making process and
deserve and trust they will receive the by giving the patient ownership of
best possible care. Evidence-based the treatment plan - ownership that
medicine merges a physician's clinical improves patient compliance. One of a
experience, external evidence provided doctor's most important roles is to give
by clinical research, and the patient's patients knowledge so that they can
unique wishes (White). Evidence-based partner effectively with their doctors
medicine is, in essence, patient-centered in shared decision-making. Involving
medicine because it places the patient patients more fully can also improve
(and his or her outcome) above conven- physician satisfaction because doctors
will be more confident they have done
tion, opinion or consensus.
what was best for the patient's individual
One example of the shift toward evi- situation. As physician-patient reladence-based medicine is the evolution of tionships are established and enriched,
mammogram recommendations. Early patients will be more satisfied as they
on, mammograms were recommended feel listened to and valued by their proannually for all women over a certain viders. Increased satisfaction of both
age. Yet as this useful screening tool physician and patient, in addition to
has been repeatedly subjected to the decreased misunderstanding between
magnifying lens of decades of clinical both parties, may even reduce the

GEORGERUDY/I23RF STOCK PHOTO

Every person possesses implicit biases. The key to preventing these biases
from adversely affecting physician-patient interactions is for both parties to
be aware of their biases and for each to
make a concerted effort to curtail such
biases in interpersonal relationships.
As attitudes and behaviors change,
communication between physician
and patient becomes more fluid and
more effective. This patient-centered
interaction leads to better relationships
and better patient outcomes.

likelihood of medically-related lawsuits.
This simple component of patient-centered medicine - involving patients in
their own care - benefits everyone.
Doctors who enable their patients
by engaging them in the treatment
team demonstrate the respect to which
patients are entitled. Sadly, some physicians knowingly or unknowingly place
themselves on a pedestal, forming a
power complex in which the patient is
expected to submit to the will of the
provider. Such attitudes and behaviors,
being doctor-centered, are the antithesis
of patient-centered medicine. By practicing patient-centered care, physicians
can avoid self-centered, ineffective
medical practice.
Physicians will have to invest effort and
energy in order to institute and refine
these elements of patient-centered medicine, but the onus of implementing these
ideals does not reside exclusively with
medical practitioners. Patients as recipients and partners must also respond
graciously as physicians make them and
their comfort the number one priority.
Much of the implementation of the principles of patient-centered medicine occurs
through attention to simple humanistic
practices in interpersonal relationships.
As implementation efforts combine with
a new wave of evidence-based medical
practice, patient outcomes will improve
and both patient and physician satisfaction with increase.
KARL ANDERSEN is a first-year
medical student at the Geisinger
Commonwealth School of Medicine. He
is a native of Utah and plans to become
an ophthalmologist.

Myers, E., Moorman, P., Gierisch J., et al. Benefits and Harms of Breast Cancer Screening: A Systematic Review. JAMA. 2015;314(15):1615-1634. doi:10.1001/jama.2015.13183.
White, B. Making Evidence-Based Medicine Doable in Every Day Practice. Fam Pract Manag. 2004 Feb;11(2):51-58.

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Table of Contents for the Digital Edition of NEPA Vital Signs - Summer Fall 2017