Patient-centered care: a Copernican shift to the center of gravity – InSight+

WHEN we look at the stars at night, we can feel insignificant and small, overwhelmed by the sheer number of celestial bodies around us. If we take the time to keep looking, we will realize that the stars and planets do not stay in the same position, but move across the night sky. Over a longer period of time, we would find that these astronomical objects seem to revolve around us.

Claudius Ptolemy, who lived approximately between 100 and 170 AD, discovered the same phenomenon. He was a polymath, mathematician, astronomer and music theorist, who, based on early astronomical observations, wrote a book called Planetary Hypotheses, in which he postulated that the sun and the planets revolved around the earth. This astronomical theory, known as geocentrism, became the accepted model for our understanding of the universe for the next 1,500 years.

And it’s no wonder it was the prevailing theory at the time and widely accepted. From where we stand as humans, we can observe two obvious things that support this geocentric model.

First, we can see that the sun and stars appear to revolve around the Earth in a consistent manner.

Second, the Earth itself appears stationary and motionless — we don’t seem to move when we’re standing still. Based on our own physical observations, it is not difficult, and even reasonable, to conclude that it is the sun, moon and stars that move and not the earth.

However, we now know clearly that this model is in fact incorrect, thanks to Nicolaus Copernicus, a Renaissance mathematician, astronomer, and physician, who came up with an opposing theory one and a half millennium after Ptolemy based on his own scientific observations, which he first introduced. published in commentary (or Small comment) in 1514, before releasing his magnus opum Dē revolutionibus orbium coelestium (or On the Revolutions of the Heavenly Spheres) in 1543. In his works he outlined his heliocentric theory of astronomy which stated that the earth and the planets revolved around the sun, which was contrary to the then prevailing scientific and religious beliefs.

Less than a century later, we have Galileo di Vincenzo Bonaiuti de’ Galilei of Italy, also a mathematician and astronomer, who was almost a doctor (apparently he went to study medicine first because he thought it was more lucrative before switching courses to find his true passion in mathematics after only one year of medicine). Galileo wrote: sidereus nuncius (or star messenger) in 1610, in which he supported Copernican heliocentrism, even though he was examined by the church for heresy in 1615.

Likewise, Johannes Kepler was a German contemporary of Galileo, as the others mentioned, a mathematician and astronomer, as well as a philosopher and music writer. He also supported Copernicus’ heliocentric model when he published a series of books culminating in: Embodiment Astronomiae Copernicanae (or Epitome of Copernican Astronomy) in 1621.

One of the reasons Copernicus, Galileo, and Kepler rejected geocentrism was because of their use of telescopes and careful measurements of the motions of the celestial bodies. In a geocentric model of the universe in which the Earth is at the center, the orbits of the sun and the planets do not follow a smooth circle or oval around the Earth as you observe their paths through the sky, but rather follow patterns created on petals. appear. a flower, paths that make many times smaller circular orbits around itself as they revolve around the earth. In fact, early astronomical maps, based on the geocentric models, showed chaotic orbits of the sun and individual planets around the Earth.

It’s only when you change the model to a heliocentric model and place the sun in the center that everything else falls into place. The orbits of the Earth and the other planets around the sun follow smooth circular or oval paths, and what we can see and measure begins to make sense.

So why did I share a brief history of astronomy with you? What does astronomy have to do with patient-centered care?

When I was an intern, I remembered how structured and orderly it felt to work in an emergency room (ED), even though the environment itself could get crowded. In an emergency room I knew my place as a physician assistant. I had a resident, a registrar and an advisor, my medical team. I had a process of triage; I knew when to see a patient, order exams and tests. I knew when to escalate, when to refer and when to fire. For me, patients came and went in a predictable way, and I did my job.

Many years later, my daughter, who was then a toddler, became seriously unwell with uncontrolled asthma, and I had to take her to the local emergency room. I had to wait a long time before I was seen. I interacted with several health professionals – nurses, doctors (both junior and senior, and several on different shifts), pharmacists and radiographers. My daughter and I were moved from the ER to radiology, back to the ER, then to the short-term ward and then to the pediatric ward.

I was given minimal information and several teams didn’t seem to know what the other teams were doing, or for that matter they didn’t even seem to care as long as they got what they needed. It was chaotic, like the orbits of stars and suns and planets spinning around me in unpredictable ways—each engaged in their own thoughts and orbits.

This was when I had an epiphany – one that is evident and is being experienced by countless other patients and family members who have come before me, and many more who will and will come after.

Even though we say the health system is patient-centered, it’s not. We’ve designed the health system to be provider-centric. Health professionals have designed processes and workflows that are useful to them. Not for nothing – we want the health system to be efficient and lean. We need to cut costs, remove waste and be cost-effective. For clinicians, the health system should revolve around them – in fact, it has been for a long time.

This means that when patients enter the health system, they experience a separate and distinct contact with different healthcare providers and teams that seem to revolve, and say they do, revolve around the patients, but in unpredictable, chaotic and “messy” orbits. Patients in need of healthcare need to talk to different people and organizations to make multiple appointments for times to suit the different care teams in a system that was clearly not designed for them, but was designed over many years and iterations for the different components of the complex world that makes up our healthcare system.

All this, despite the fact that patient-centered care is now part of the language of every public and private hospital, and that every project is now required to be designed with the consumer. We still live with the health model that is “provider-centered” rather than based on true “patient-centeredness”. Clinicians are still the center of gravity because we still have the locus of control.

This must change.

To be truly patient-centric, we need to take the radical step of dismantling the structures that already exist in the various care teams to make each of the parts individually more efficient, and really design a single system from scratch that connects the patient with the middle. This is so that, from the patient’s perspective, they are the ones who are really stable and immobile, and they can experience care teams around them in a predictable, orderly way.

This is a model of a universe where the patient has the control and ability to get the right care and information from the right healthcare provider at the right time; a universe that is peaceful and structured for the patient, even at the cost of more chaos, inefficiencies and costs for the caregivers (although this may not be the case). This model of the universe is “patient-centeredness”. This model of health care may not be practical for some in our current decentralized, fragmented and compartmentalized health system, and may even be considered heretical by others.

But I know that astronomy lived with the wrong model of the universe for 1500 years before a few came up with a new theory. I would rather propose today a new theory of health care that could perhaps become the predominant model, hopefully in a shorter period of time than that.

Professor Erwin Loh is Group Medical Officer and Group General Manager of Clinical Governance at St Vincent’s Health Australia.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MYA or InSight+ unless so stated.

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