Various forms of applied social psychologyConstructing horizontal relationships between patients and experts: Toward the realization of patient-centered care.
“Patient-centered care.” “Patient-centered treatment” These are phrases that have been used in the past, and recently are heard even more frequently. “Patients becoming subjects and receiving support and care,” simply stated, means patients actively gathering information on their own illness and medical treatment, considering it, and on the basis of having done so deciding on a course of treatment. Realizing this in practice, however, is not such a simple task.
There are several factors that make the realization of patients as subjects difficult, but perhaps the largest of these is the disparity of information between doctors and patients. It is not as though we all have sufficient information about illnesses and medical treatments. When we get sick we can get information from the Internet, books, or the people around us, but it is difficult to match the up-to-date information and sheer quantity of knowledge possessed by doctors in their role as treatment providers. And in cases such as when the disease is unusual or involves large differences between individuals, gathering information becomes markedly more difficult. This disparity of information about illness and treatment is a factor that gives rise to asymmetry between the positions of doctors and patients. This leads patients who have doubts about the course of treatment proposed by their doctor to think, “If I tell my doctor about my doubts it may destroy our relationship, and I may no longer be able to receive good care.” This power imbalance between patient and doctor that comes with their disparity of information becomes a cause of what is referred to as “paternalism,” a treatment relationship in which the doctor has the right to decide on a course of treatment and then force it on the patient.
Treatment administered through this kind of relationship is a long way from treatment given to a patient as a subject. So how can we avoid falling into paternalism, eliminate the disparity of information within the context of an equal relationship (horizontal human relationship – cf. Satō 2007) between doctors and patients, and realize support and treatment for patients as subjects? Two initiatives that have been undertaken to this end are a “personal decision guide” and “community building in which citizens and healthcare professional think about illness together.”
The Ottawa Personal Decision Guide
The Ottawa Personal Decision Guide is composed of five steps, “1. Clarify your decision,” “2. Specify your own role in your decision,” “3. Identify your decision making needs,” “4. Compare and examine your options” and “5. Plan your next steps,” and assists patients in thinking about their own treatment and conveying their decisions to their healthcare providers (Arimori, 2015).
Community building in which citizens and healthcare providers think about illness together
Initiatives are being implemented to establish places for dialogue between healthcare providers, patients and their families, and ordinary citizens in local communities and facilitate their mutual understating of each other’s values. One of these is something called “café-style” health communication (Son, 2013). In “café-style” health communication, citizens and healthcare providers discuss illness and health from positions of equality, creating a venue for them to understand each other’s values. These places serve to reduce the disparity of information between citizens who have less and healthcare providers who have more and break down the asymmetrical relationship between healthcare providers and citizens this disparity creates, and constitute an initiative aimed at moving closer to the construction of horizontal human relationships.
The Ottawa Personal Decision Guide and initiatives such as café-style health communication are important undertakings for the realization of support and treatment of patients as subjects. When it comes to these sorts of initiatives, it seems that demand for research and practical application will only increase going forward.
- Sato, T., (2007). Bottom-up human relationship; 12 sites of psychology, education, welfare, environment, society: Toshindo
- Son, D., (2013). Facilitator of dialogue-based communication and reflective practice. Japanese Journal of the Japan Primary Care Association, 36, 124-126.
- Arimori, N., (2012). Chapter 5 Decision support in reproductive health, Nakayama, K., Iwamoto, T. (Eds). Decision Support Guidebook: Chuohoki Publishing.