In an essay in Health Affairs last year, Don Berwick, President Obama’s nominee to head the Centers for Medicare and Medicaid Services, surveys the debate in the health policy community over how the principle of “patient-centeredness” should be defined and implemented. In his piece, titled “What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist,” Berwick offers his own definition of patient-centeredness and spells out how his view would change the way the health care system operates.
For example, “leaving choice ultimately up to the patient and family means that evidence-based medicine may sometimes take a back seat,” Berwick says. “One e-mail correspondent asked me, ‘Should patient “wants” override professional judgment about whether an MRI is needed?’ My answer is, basically, ‘Yes.’ On the whole, I prefer that we take the risk of overuse along with the burden of giving real meaning to the phrase “a fully informed patient.” He explains:
I contemplate in this a mature dialogue, in which an informed professional engages in a full conversation about why he or she—the professional—disagrees with a patient’s choice. If, over time, a pattern emerges of scientifically unwise or unsubstantiated choices—like lots and lots of patients’ choosing scientifically needless MRIs—then we should seek to improve our messages, instructions, educational processes, and dialogue to understand and seek to remedy the mismatch.
Health Affairs is making this article and other Health Affairs articles by and about Berwick freely available to all. These resources include:
Donald M. Berwick, What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist, Health Affairs, July/August 2009; 28(4) w555-w565
Donald M. Berwick, Thomas W. Nolan, and John Whittington, The Triple Aim: Care, Health, And Cost, Health Affairs, May/June 2008; 27(3): 759-769
Donald M. Berwick and Madge Kaplan, ‘What’s The Ethics Of That?’ A Conversation with Thomas O. Pyle, Health Affairs, January/February 2008; 27(1): 143-150
Donald M. Berwick, Nancy-Ann DeParle, David M. Eddy, Paul M. Ellwood, Alain C. Enthoven, George C. Halvorson, Kenneth W. Kizer, Elizabeth A. McGlynn, Uwe E. Reinhardt, Robert D. Reischauer, William L. Roper, John W. Rowe, Leonard D. Schaeffer, John E. Wennberg, and Gail R. Wilensky, Paying For Performance: Medicare Should Lead, Health Affairs, November/December 2003; 22(6): 8-10
Sheila Leatherman, Donald Berick, Debra Iles, Lawrence S. Lewin, Frank Davidoff, Thomas Nolan, and Maureen Bisognano, The Business Case For Quality: Case Studies And An Analysis, Health Affairs, March/April 2003; 22(2): 17-30
Rae M. Lamb, David M. Studdert, Richard M.J. Bohmer, Donald M. Berwick, and Troyen A. Brennan, Hospital Disclosure Practices: Results Of A National Survey, Health Affairs, March/April 2003; 22(2): 73-83
Donald M. Berwick, Quality Chasm Factors, Health Affairs, September/October 2002; 21(5): 301-302
Donald M. Berwick, A User’s Manual For The IOM’s ‘Quality Chasm’ Report, Health Affairs, May/June 2002; 21(3): 80-90
On Health Affairs Blog:
Don Berwick’s Vision: The Triple Aim, April 20, 2010
CMS Nominee Berwick On Empowering Patients And Improving Quality, March 28, 2010
Berwick On Patient-Centered Care: Comments And Responses, July 9, 2009