Putting the Patient First

Students engaging in discussion on the topic of patient-centred care

How do you feel about the treatment you receive when you seek healthcare? Do doctors, nurses and other professionals listen to your concerns, care about your needs, value your opinion and provide you with sufficient information about your health? And what can and should you do to take a more active role in determining the appropriate care for your particular needs?

An in-depth discussion on this notion of patient-centred care was led by Dr. Nick Kates, acting chair in the Department of Psychiatry and Behavioural Neurosciences at McMaster University, and Charles Cunningham, a professor in the same department, at the third and final event in the Café Scientifique series hosted by the McMaster Health Forum Student Subcommittee.

The fundamental message that resonated throughout the discussion was that although we are making strides in this area, we are still miles away from developing a system that provides us with better health, better care, and better value. Dr. Kates describes patient-centred care as a way in which the healthcare system is designed and delivered in order to address the healthcare needs and preferences of patients, and that is appropriate and cost-effective. A high-functioning healthcare system includes attributes such as accessibility, effectiveness, safety, efficiency, integration, and above all, be consumer- and family-centred. By evaluating the current state of healthcare systems, the road to improvement can be split into three goals: better health for populations, better experiences of seeking and receiving care, and sustainable/cost-effective delivery of care.

Involving the patient as a partner in healthcare is one of the ultimate goals of patient-centred care. The principles of respect, choice and empowerment, involvement in health policy, and access and support are integral components in enhancing a patient’s experience, as well as introducing the patient perspective in the governance of health systems in the future. Transparency and individualization pertaining to the patient-doctor relationship is one of the initial steps in allowing patients to make decisions concerning their own care, as well as providing the doctor with key knowledge regarding the patient’s unique experience and context of the individual situation. Providing necessary information to patients, such as access to their charts and copies of all notes and reports, is another crucial attribute of the “activated” patient as a partner in care, since the majority of the time the patient will be monitoring and managing their own care. Being more involved and having a fully-understood plan for treatment allows patients to be active and effective agents in their own care.

With regards to research in this field, in order to find the most effective methods of patient-centred care economists must rely on complex choice methods. According to Cunningham, a major flaw in the survey method of data collection is that questions don’t accurately simulate the real world choices patients are facing. Through the complex choice method, attributes selected by patients regarding patient-centred care included doctors taking the time to get to know patients on an individual basis, understanding the patient’s concerns and experiences, and treating patients with respect. Current research has shown that patients and theorists have different perspectives on the notion of patient-centred care, which has led to the development of interesting economic questions such as how can the value of collaborative decisions be determined. Above all, prompt and detailed feedback and effective communication between healthcare teams have been deemed among the most important features of patient-centred care.

In moving forward with patient-centred care, it is imperative to use patients’ experiences to gain insights in improving the operation of healthcare systems nationwide. Through the use of focus groups, actively involving patients in the design of the system, and supporting individuals to manage their own care, new dimensions of patient-centred care can be explored. The future role of patients in the governance of health systems can aid the transition from patient-centred to patient-driven, and finally, patient-owned care. After all, according to the British Design Council of 2004, “The biggest untapped resources in the health system are not doctors but users.”

To view or listen to the interviews with Café speakers and participants, please visit our YouTube channel at

By Asha Behdinan, Finance Coordinator and Co-chair 2013-2014, McMaster Health Forum Student Subcommittee

Facilitators Charles Cunningham (right) and Nick Kates (left)

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