Patient-centered care: A Copernican shift to the center of gravity – InSight+

WHEN we look at the stars at night, we can feel insignificant and small, overwhelmed by the large number of celestial bodies around us. If we take the time to keep looking, we will realize that stars and planets do not stay in the same position but move across the night sky. Over a longer period, we would discover that these astronomical objects seem to revolve around us.

Claudius Ptolemy, who lived approximately between 100 and 170 AD, also discovered the same phenomenon. A polymath, he was a mathematician, astronomer and music theorist, who, based on the first astronomical observations, wrote a book called Planetary assumptions, in which he postulated that the Sun and the planets revolved around the Earth. This astronomical theory, known as geocentrism, became the accepted model for our understanding of the universe for the next 1500 years.

And it’s no wonder that this was the dominant theory at the time and widely accepted. From where we stand as human beings, we can observe two obvious things that support this geocentric model.

First, we can see that the Sun and the stars seem to revolve around the Earth in a coherent fashion.

Second, the Earth itself appears stationary and still – we don’t seem to move when we’re still. Based on our own physical perceptions, it is not difficult, and even reasonable, to conclude that it is the Sun, the Moon and the stars that move and not the Earth.

However, we obviously now know that this model is, in fact, incorrect, thanks to Nicolaus Copernicus, a Renaissance mathematician, astronomer and physician, who, a millennium and a half after Ptolemy, proposed an opposite theory based on his own science. scientific. observations, which he first published in Comment (Where short comment) in 1514, before releasing his magnus opum De revolutionibus orbium coelestium (Where On the revolutions of the celestial spheres) in 1543. In his works, he expounded his heliocentric theory of astronomy which postulated that the Earth and the planets revolved around the Sun, which was contrary to popular scientific and religious beliefs at the time.

Less than a century later, we have Galileo di Vincenzo Bonaiuti de’ Galilei from Italy, also a mathematician and astronomer, who was almost a doctor (he apparently started medical school because he thought it was more profit before changing course to pursue his studies, a real passion for mathematics after only one year in medicine). Galileo wrote Sidereus noncius (Where Star messenger) in 1610, in which he supported Copernican heliocentrism, although he ended up being investigated by the Church for heresy in 1615.

Likewise, Johannes Kepler was a German contemporary of Galileo, like the others mentioned, a mathematician and astronomer, as well as a philosopher and music writer. He also supported Copernicus’ heliocentric model when he published a series of books culminating in Quintessence astronomiae Copernicanae (Where Quintessence of Copernican astronomy) in 1621.

One of the reasons Copernicus, Galileo and Kepler rejected geocentrism was their use of telescopes and careful measurements of the movements of celestial bodies. In a geocentric model of the universe where the Earth is at the center, the orbits of the Sun and the planets do not trace a smooth circle or oval around the Earth if you observe their trajectories in the sky, but rather follow patterns that look like petals to a flower, paths that make many smaller circular orbits around themselves multiple times as they orbit Earth. In fact, the first astronomical maps based on geocentric models showed chaotic orbits of the Sun and individual planets around the Earth.

It’s only when you change the model to a heliocentric model and place the Sun in the center that everything else falls into place. The orbits of Earth and other planets around the Sun follow smooth circular or oval paths, and what we can see and measure is beginning to make sense.

So why did I share with you a brief history of astronomy? What does astronomy have to do with patient-centered care?

When I was an intern, I was reminded of how structured and orderly it was to work in an emergency department (ED), even though the environment itself could be busy. In an emergency department, I knew my place as a young doctor. I had a resident, a registrar and a consultant, my medical team. I had a triage process; I knew when to see a patient, examine them and order tests. I knew when to escalate, when to refer and when to unload. For me, patients came and went predictably, and I did my job.

Several years later, my daughter, who was a toddler at the time, became seriously ill with uncontrolled asthma, and I had to take her to the local emergency department. I had to wait a long time to be seen. I had contact with different healthcare workers – nurses, doctors (both junior and senior, and different on different shifts), pharmacists and radiographers. My daughter and I were moved from the ER to radiology, back to ER, then to the short-stay ward, then to the pediatric ward.

I was given minimal information, and different teams didn’t seem to know what other teams were doing, or for that matter, didn’t even seem to care, as long as they got what they needed. It was chaotic, like the orbits of stars, suns and planets spinning unpredictably around me – each busy with their own thoughts and tasks.

It was then that I had an epiphany – an epiphany that is evident and experienced by countless other patients and family members who have come before me, and many others who have come and who will come later.

Even though we say that the healthcare system is patient-centred, it really isn’t. We designed the health system to be provider-centric. Healthcare workers have designed processes and workflows that are useful to them. For a good reason – we want the healthcare system to be efficient and lean. We need to reduce costs, eliminate waste and be profitable. For clinicians, the healthcare system should revolve around them – in fact, it has long done so.

This means that when patients enter the healthcare system, what they experience is separate and distinct contact with different healthcare providers and teams who seem and say they revolve around patients, but in unpredictable ways, chaotic and “messy”. orbits. Patients in need of health care have to talk to different people and organizations to book multiple appointments at times that suit different care teams in a system that is clearly not designed for them, but designed over many years and iterations for the different components of the complex world that make up our healthcare system.

All this, despite the fact that patient-centered care has become part of the language of every public and private hospital, and that every project is now mandated to be co-designed with consumers. We still live with the healthcare model that is “provider-centric” rather than based on true “patient-centricity”. Clinicians are still the center of gravity because we still have the locus of control.

This must change.

To be truly patient-centric, we need to take a radical step by dismantling the structures that already exist in the different care teams to make each of the parts separately more effective, and really design from scratch a single system that puts the patient at the center. This is how, from the patient’s perspective, they are the ones who are truly stable and still, and they can experience the healthcare teams around them in a predictable and orderly way.

It is a universe model in which the patient has control and the ability to get the right care and information from the right provider at the right time; a peaceful and structured universe for the patient, even if this comes at the expense of more chaos, inefficiencies and costs for the providers (although this is not necessarily the case). This model of the universe is “patient-centrism”. This model of health care may not be feasible in our current decentralized, fragmented and siloed health care system, according to some people, and may even be considered heretical by others.

But I know astronomy lived with the wrong model of the universe for 1500 years before a few came up with a new theory. Rather, I would suggest a new theory of health care today that could perhaps become the dominant model, hopefully in a shorter period of time than that.

Professor Erwin Loh is Group Physician and Chief Executive of the Clinical Governance Group at St Vincent’s Health Australia.

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