5.1.2. Patient centeredness

More than 80% of medical consultations are due to chronic diseases which cannot be healed, but which can be cured and well controlled. The quality of control is directly dependent on how the patient and his/her family have been educated as to how to control the disease. Patient-centeredness is one of the most fundamental expressions in care and also one of the most overused. The bearer of a disease, the patient, is a unique person totally different from another patient who may suffer from the same disease and may have the same type of care. This gives weight to the concept of illness versus disease, the latter being much easier to define and which responds to the various concepts of biomedicine and evidence-based therapy. Patient-centeredness is a most complex and heterogeneous reality. It shows how difficult it is to define care since its efficiency is the result of a whole series of human and institutional factors. In order to globally encompass the two basic dimensions for helping a patient, patient-centeredness can be subdivided in dimension of care and psycho-social dimension. Both dimensions represent the two sides of patient-centeredness. They always have to be read and discussed “simultaneously”. Difficulties in care delivery often arise because these dimensions were not taken globally and simultaneously into account. Patient care oscillates between technical dimensions; lab tests, x-rays, hospital care, financial coverage through medical insurances, as well as the role of the pharmaceutical industry and drugs, but these diagnostic and therapeutic tools are strictly bound to epidemiological data and medical education which are promoted by the World Health Organization, national health organizations, medical schools, schools of nursing and other relevant Organizations. At national level, health decision makers are also following the recommendations of their national health policy. There are other dimensions that deal with patient rehabilitation, home visiting nurses, therapeutic patient education and patient associations who all participate to a large degree to the care process. The doctor, in the field of biomedicine can be symbolized by the specialist who is concentrated on making a diagnosis and is worried that he may misread in case of little or even no dialogue with his patient.

Chronic diseases and their treatments can easily interfere with many aspects of life, work, family life, leisure pursuits and close relationships, i.e. all the things we probably care most about. Doctors and nurses have to understand and work taking into account all these issues in case of long lasting diseases. A successful management of the disease is closely linked to personal health beliefs as well as to the spiritual dimensions of the patient. Of course, coping and psychological adjustment may vary depending on  each patient, but are also the result of the interaction of the family, friends, and healthcare providers. The complexity and heterogeneity of care are not so easy to understand, as the quality of care does not depend only on two or three factors but rather a sort of strange alchemy of many different factors.