Island Voices: Is patient-centred health care a desirable goal, or just hype?

Re: “Support team could help with physician shortage,” comment, Sept. 16.

In the past 10 years, the B.C. government has developed initiatives around patient-centred care, highlighting this as a key priority in health care.

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Feel-good statements such as using an “integrated system of health care that works for patients, not just for us,” in my opinion, just aren’t packing a punch as far as outcomes go.

Ironically, this statement was made by the deputy health minister discussing the need to “roll up our sleeves” and take action in an effort to change the system toward a patient-centred focus. And yet the current initiatives to create a patient-centred model of care do nothing to support the grassroots relationship between care providers and patients.

A case in point: When was the last time during your 10-minute medical appointment you were given the option to discuss your treatment risks and benefits, your alternatives to treatment or your decision not to treat, or your plan of care going forward? If you have been a patient in hospital, would you be able to say the relationship between you and your physician/surgeon was collaborative and patient-centred or did each interaction with your health-care provider seem rushed and leave you with more questions?

The B.C. government says patient-centred care encourages patients to self-manage their care and share in the decision-making process with their health-care provider, which results in improved information and understanding. This is a concept otherwise known as shared decision-making.

Shared decision-making is different from informed consent. Informed consent is a legal requirement for a health-care provider to provide information about a specific diagnosis or treatment. Shared decision-making supports a relationship, not a legal contract, between health-care providers and patients.

Given that shared decision-making falls under the government’s definition of patient-centred care, I find it odd that there is very little mention or tangible support for this type of decision-making in our provincial health-care system. In fact, it seems that there is a large focus on primary care and increasing funds for more health-care providers and clinics — all great things — but it actually serves as a smokescreen for what the real issue is: Our current (and primarily fee-for-service) medical model of care is still very paternalistic and treats people like cattle.

The recent commentary published in the Times Colonist discussed the use of nurse practitioners (as well as physician assistants and nurses) as a means to support physicians in their practice. As a nurse practitioner, I take offence to this.

Nurse practitioners are autonomous providers of health care, who not only diagnose, order tests and prescribe much like physicians, but most importantly provide “whole person” patient care. NPs act as a bridge between nursing and medicine.

The NP role is to support patients, not physicians. NPs are not physician substitutes, physician extenders or physician helpers; we work as part of a team, but we are not physician employees or “gap fillers” for the physician shortage.

We are trained to care for the entire patient, their families and their community, not just the disease. Therefore, NPs should be in all areas of health care, in acute and primary-care areas to provide the patient-centred care we have been trained to provide, a care model the government has promised to prioritize, support and uphold.

The next time you hear “physician shortage,” please stop referring to nurse practitioners. Instead, think of NPs when you think of shared decision-making, holistic care, disease prevention and patient-centred care.

Collette Melo has been a nurse practitioner for more than eight years and is an advocate for a new model of care that supports structured interdisciplinary bedside rounds and shared decision-making in acute care. She works in Victoria.

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