Patient, not Person-Centered Care

I remember the first day I interviewed a standardized patient in medical school we were given a sheet of paper with a checklist of questions we needed to ask our patients. “Where is the pain? Does it radiate? What does it feel like? On a scale of 1-10, with 1 being no pain and 10 being the worst pain you’ve ever felt, how does your pain feel?” There was a total of 23 questions on our checklist, a number that seemed daunting to someone who just learned how to properly introduce herself. Question #10 on our checklist read, “Patient’s perspective.” I wasn’t really sure what that meant, and for the first couple of sessions with a standardized patient I glazed over it, focused more on getting the chief complaint and getting the dosages and names of drugs that patients took correctly. After each session, I always got the same comment: “Next time remember to ask for the patient perspective!” Annoyed that I kept missing the same 1 question every time, the next time I went to see a standardized patient I wrote on my clipboard, “PATIENT POV” in large letters across the top of the page before the start of the interview. The patient I had was a middle aged man who came in with symptoms of unexplained weight loss, night sweats, and nausea and vomiting. When I finally made it to question #10 I asked, “What concerns you the most about why you came in today?” The patient paused, looked down for a long time, and then looked up at me with tears in his eyes. Besides being floored by how good his acting skills were (do they teach acting lessons when you sign up to be a standardized patient?!), I had chills because he told me, “I’m afraid I have cancer. My father and brother died from it, and I’ve been too scared to go to a doctor for so long because they both had my same symptoms. I need your help…if it is cancer–please–just help me live long enough to watch my daughter graduate from college.” I remember stumbling over my words, trying my best to be empathetic and assuring while trying to finish the rest of the interview in the 15 minutes we were given. I walked out of the room feeling sad, helpless, and even a little bit angry.

My reaction to this scenario seemed weird to me, and I remember trying to figure out why I was so shaken up by this encounter. I mean, the story was entirely fiction. The standardized patient was working off of a script; I knew that. I knew I wasn’t shaken up because of the possible cancer diagnosis I wrote in the chart after the session, because I had interviewed standardized patients with similar stories that pointed towards a cancer diagnosis before. I finally realized what was so devastating to me: even though this specific encounter with this standardized patient was fiction, it really wasn’t fiction. In our senior year of college, a close friend of mine had her father diagnosed with late-stage cancer. I remember talking with her one night and her repeating the same words the standardized patient said, that her father wanted “just long enough to watch her graduate college.” Her father lived long enough to see my friend graduate, but died in the following months after, before he could watch his other daughter walk across the same stage.

I was reminded of this story when we spoke about patient-centered care vs. person-centered care during our time at Telluride. The poll, “Should the term be called patient-centered care or person-centered care?” was shown on the screen and within seconds “person-centered care” won the majority of the votes. However, me and a couple of others in the room voted for “patient-centered care.” Our explanation was because we felt like the word patient already carried within it the connotation of the word person. How could you be my patient if I didn’t already see you as a person? How could you be my patient if I didn’t take the time the listen to your concerns, goals, and background? The day I met with that particular standardized patient was the day I learned that the patient perspective is one of the most important parts of a patient’s health history, because it is an opportunity for you to see the patient as not just “cancer in room 4,” but as my patient, Mr. Smith. From that day forward I never forgot that question in any of my standardized patient interviews. My time at Telluride has only just reinforced my opinion that question #10 in our checklist is as vital as the chief complaint, and that our duty is to treat our patient, not the disease.