Patient-Centered Concussion Care
What is Patient-Centered Care in Medicine?
In June 2023, Conor Gormally, Co-Director of Concussion Alliance, and I presented our Med Learning Group CME program and website resources to the physical medicine and rehabilitation (PM&R) residents at the University of California Davis School of Medicine. Our discussion on concussion education sparked a lively exchange about patient-centered concussion care.
The word “patient” comes from the Latin word for suffering and highlights what brings patients into the healthcare system for care. First presented decades ago, “patient-centered care” describes an innovative way to transform healthcare delivery. The concept challenges long-standing biomedically oriented and paternalistic views about medicine by going beyond a procedural approach to diagnosis and treatment.
Patient centered approach to healthcare delivery:
- Values relationship-building between the patient and the physician or other healthcare professional, through empathy, and respect, and excellent communication.
- Emphasizes prevention and health promotion through engagement and education.
- Strives to deliver individualized, holistic, and coordinated care that includes shared decision-making. No longer a passive recipient in this model, the patient instead participates actively in their healthcare.
Over the last several decades, the Institute of Medicine (now part of the National Center for Medicine and Science) and the Centers for Medicare and Medicaid Services have promoted the patient-centered care approach to healthcare delivery. The benefits of patient-centered care include improved patient satisfaction, greater enablement, a decrease in symptom burden, and positive health outcomes.
Challenges and Possibilities of Patient-Centered Care
But is patient-centered care now an unreachable pie-in-the-sky idea? In the last several decades, healthcare and healthcare systems in the United States have changed.
- A push for productivity and profits, as well as technological advances such as the electronic medical record, have changed patient-provider interactions.
- Patient-provider interactions and procedures are now measured for efficiency rather than satisfaction or the other values of patient-centered care.
- Burnout statistics for healthcare professionals bear out the consequences of this productivity-driven turn.
- Current efficiency demands in medicine are even causing “moral injury” to physicians, forcing them to make decisions at odds with what they perceive is the best course for a patient’s health.
Transforming Concussion Care Through Patient Self-Advocacy
Conor sustained several concussions during his high school and college years and still suffers from chronic symptoms. The healthcare encounters following these injuries were not patient-centric, and he and his family struggled to learn about his condition and find effective treatments. Their experiences catalyzed the formation of Concussion Alliance, an organization that helps patients become more educated and engaged participants in their healthcare.
Concussion Alliance and I have developed website resources for patients and their families to help transform the concussion care they receive. For example, the Concussion Checklist can help patients prepare for a visit to the emergency room or primary care clinic. Concussion Alliance’s website resource on Finding Providers is useful for educating concussion patients about the types of care certain healthcare professionals are trained to provide.
For more information about concussion care, sign up for newsletters here (Concussion Alliance) and here (Elizabeth Sandel, MD). My book, Shaken Brain: The Science, Care, and Treatment of Concussion (Harvard University Press, 2020) also offers comprehensive and practical information for readers.
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Elizabeth Sandel, MD, a physiatrist and brain injury medicine physician, and Conor Gormally, co-founder of Concussion Alliance — a young man who has experienced several concussions — present a patient-centered care approach for emergency medicine and primary care physicians.
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