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Don Berwick and Patient Centered Care


A few weeks ago I' had the oppor'­tunity to hear Dr. Don Berwick speak at the annual meeting of the Asso'­ci'­ation of Health Care Jour'­nalists.

Berwick now heads the Centers for Medicare & Med'­icaid Ser'­vices. When he spoke in April, on trans'­parency and how we might simul'­ta'­ne'­ously 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 con'­ference in 2009. Here, he tackles the meaning of patient-centered care. It's near-perfect:

My favorite lines:

'The errors and unre'­li'­a'­bility 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' hos'­pital gown, homog'­e'­nized, anonymous, pow'­erless, 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 lan'­guage of med'­icine in a' way few doctors, in my expe'­rience, do. He's not so much afraid of data and making deci'­sions or even errors, which are in theory sur'­mountable problems, through better infor'­mation and edu'­cation, and despite every'­thing may not lead to a 'cure' or even a' person's sur'­vival, per se. He most fears being per'­ceived as an object, without respect for his con'­cerns and preferences.

That is my greatest fear,' too.

More Blog Posts by Elaine Schattner

author bio

Elaine Schattner, M.D., is a trained oncol­ogist, hema­tol­ogist, edu­cator and jour­nalist who writes about med­icine. Her views on health care are informed by her expe­ri­ences as a patient with sco­l­iosis since childhood and other con­di­tions including breast cancer. She is a Clinical Asso­ciate Pro­fessor of Med­icine at Weill Cornell Medical College, where she teaches part-time. She holds an active New York State medical license and is board-certified in the Internal Med­icine sub­spe­cialties of Hema­tology (blood dis­eases) and Oncology (cancer medicine). She writes regularly on her blog, Medical Lessons. You can follower her on Twitter @ElaineSchattner.

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dirk says
June 25, 2011 at 11:20 AM

modern medicine, with all if its technology, is a branch of mechanics and there is always a danger of being reduced to parts, and or being lost (losing one's unique author-ity) in a system which calculates/prioritizes choices, manages resources, in terms of statistics, evidence, and or best ( for whom?) practices.
but there is another danger at hand in these matters which is that the patient, in an understandable desire to turn back the clock, can wish to render their bodies invisible,
to deny their uncanny identity with the functions and limits of their flesh and this can be a serious barrier to their being attuned to their bodies and to taking responsibility/ownership of the daily demands of their treatment.
We need an intimacy with the body that does not deny its machinic aspects but also does not reduce our humanity to such functions and such a task/achievement is beyond the current education of medical providers and patients alike.