Division of Nephrology and Kidney Research Institute, University of Washington; and Veterans Affairs Puget Sound Health Care System, Seattle, WA.
Am J Kidney Dis. 2018 May;71(5):732-736. doi: 10.1053/j.ajkd.2017.11.022. Epub 2018 Feb 9.
There is growing interest in patient-centered care, defined by the Institute of Medicine as "care that is respectful of and responsive to individual patient preferences, needs, and values." Although generally accepted as uncontroversial, the notion of "centering" care on our patients is in fact quite revolutionary. Because medical teaching, research, and practice have traditionally been organized around diseases and organ systems rather than patients, making care more patient centered would require no less than a paradigm shift in how we practice medicine. This would call for a frameshift in how we envision our role as health care providers and fundamental changes to the health care delivery systems in which we practice. Although individual providers may have limited power to change health systems (at least in the short term), there are some simple strategies within our reach that can help make our care more patient centered. These include a willingness to listen, make time, go beyond our job description, re-imagine what it means to provide "good" care, and see value in relationship building. Although putting these practices to work in the complex, specialized, and fragmented health systems in which many of us operate may be challenging, I would argue that this is a "beautiful challenge" with potentially far-reaching benefits for both patients and providers.
人们对以患者为中心的护理越来越感兴趣，这一定义由美国医学研究所界定为“尊重和响应个体患者的偏好、需求和价值观的护理”。尽管“以患者为中心”的概念被普遍认为是无可争议的，但事实上，将护理的重点放在患者身上是相当具有革命性的。因为医学教学、研究和实践传统上是围绕疾病和器官系统而不是患者组织的，所以要使护理更加以患者为中心，就需要我们在实践医学的方式上进行范式转变。这将要求我们重新设想自己作为医疗保健提供者的角色，以及我们实践的医疗保健提供系统进行根本性变革。尽管个别提供者可能在改变医疗体系方面的权力有限（至少在短期内是这样），但我们可以采取一些简单的策略，使我们的护理更加以患者为中心。这些策略包括愿意倾听、抽出时间、超越我们的工作职责、重新想象提供“好”护理的含义，并看到建立关系的价值。虽然在我们许多人所运作的复杂、专门化和碎片化的医疗体系中实施这些做法可能具有挑战性，但我认为，这是一个“美丽的挑战”，对患者和提供者都可能产生深远的好处。
