In this uncertain world, patient-centred care must not mean patient-led care

Abstract

NAVIGATING THE DIAGNOSIS Picture the scene: you are climbing down a mountain and the fog descends. You can no longer see further than 5 metres. The two-dimensional map you are following does not capture the three-dimensional landscape you are navigating; you cannot get your bearings, and you do not know what is coming. Now imagine that you are with a guide who has walked the path you are on thousands of times before. What would you want them to do? The similarities between helping an individual to navigate a treacherous mountain and the process of making a diagnosis and treatment plan in primary care make this a pertinent analogy. The primary care physician navigates undifferentiated diagnostic situations, simultaneously processing the biological, psychological, and social aspects of the presentation. 1 This process of decision making in the face of uncertainty requires learnt intuition: utilising the technical, personal, and conceptual skills of the GP. These skills arise from prolonged practice, exposure, and feedback. 2 Just as the mountain guide draws on their honed intuition to provide a path to safety, so too does the GP. However, this professional intuition is under attack. An article in the Telegraph proposed that we should do away with GPs and that the public should provide their own primary care with 'apps, robots, online self-diagnosis and over-the-counter medicines'. 3 A popular view is that this is the natural extension of patient-centred care, facilitating patients to make informed, autonomous decisions. But if patients are being asked to sort and prioritise their own symptoms, and analyse and choose options available to them, this is not so much patient-centred as patient-led care. ADVERSE CONSEQUENCES OF PATIENT-LED CARE Although there are some conditions and minor illnesses for which this patient-led approach will be effective, unfortunately there are also many situations where this approach may be ineffective and/or dangerous. The clinical process is shrouded in uncertainty. GPs apply their skill and experience to rule out or investigate the worrying and sinister causes, and frequently utilise watchful waiting and bestfit treatments as diagnostic tools. They

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“…For example, Miller and colleague stressed the need to recognise the importance of learnt intuition and skills of trained healthcare providers such as GPs in providing patient care. The authors emphasised the importance of integrating PCC to encourage a doctor‐led and patient‐centred approach rather than a patient‐led care approach (Miller & Fritz, 2019 ).…”

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“…There was no significant difference in measures of disability, participation, or autonomy, but fatigue (physical scale and total scale) and health-related quality of life (bodily pain and vitality) were better in the usual care group. Miller and Fritz (2019) argues that patient-centred care should not mean patient-led care. He noted that patient-led care can have adverse outcomes, including harm via lack of responsibility, neglect, a widening health gap, missed diagnoses, and mental health impact.…”

“… Miller and Fritz (2019) argues that patient-centred care should not mean patient-led care. He noted that patient-led care can have adverse outcomes, including harm via lack of responsibility, neglect, a widening health gap, missed diagnoses, and mental health impact.…”