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Usually we talk about participatory medicine at the level of the individual care relationship, but increasingly we’re seeing the need to “Design and create a safe, decent, patient centered healthcare system.” And as we start to get real about that – concrete, tangible change– I’ve heard people wonder, “What do they mean by patient-centered?”

Thanks to SPM member Elaine Schattner, MD for this June post, cross-posted with permission, that answers the question definitively. It’s about a three minute clip of a 2009 talk by Don Berwick – on why he fears becoming a patient some day.

A few weeks ago I had the opportunity to hear Dr. Don Berwick speak at the annual meeting of the Asso­ci­ation of Health Care Jour­nalists.

Berwick now heads the Centers for Medicare & Med­icaid Ser­vices. When he spoke in April, on trans­parency and how we might simul­ta­ne­ously cut costs and improve care, I thought his talk was pretty good. This morning, through Twitter, I came upon a short clip from a Berlin con­ference in 2009. Here, he tackles the meaning of patient-centered care. It’s near-perfect:

My favorite lines:

…The errors and unre­li­a­bility of health care are not the main reason that I fear that inevitable day in which I will become a patient…I can use my own wit to stand guard against them…


…What chills my bones is indignity. It is the loss of influence on what happens to me. It is the image of myself in a hos­pital gown, homog­e­nized, anonymous, pow­erless, no longer myself. It is the sound of young nurse calling me “Donald” which is a name I never use, ‘It’s “Don.’…

It is the voice of the doctor saying ‘we think,’ instead of ‘I think,’ and thereby placing that small verbal wedge, the pronoun ‘we,’ between himself as a person and myself as a person…


Why I like this clip so much is that Berwick gets the nuanced lan­guage of med­icine in a way few doctors, in my expe­rience, do. He’s not so much afraid of data and making deci­sions or even errors, which are in theory sur­mountable problems, through better infor­mation and edu­cation, and despite every­thing may not lead to a “cure” or even a person’s sur­vival, per se. He most fears being per­ceived as an object, without respect for his con­cerns and preferences.

That is my greatest fear, too.


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