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Is patient centred care rhetoric or an achievable goal?

11 November 2015 Jonathan Faurie

We are all aware of the current state of the South African medical care industry. Recent reports regarding the public healthcare system highlights the fact that medical cover is becoming a necessity in order to ensure that you receive the best hospital care possible.

However, medical negligence is not exclusively the realm of public healthcare. There have been reports in the past that negligence is also found in private hospitals. Patient centred care is a growing concern around the world as it is becoming an ideal rather than a reality.

The long road

But has this always been the case? Historically, South Africa has been at the forefront of many medical advancements that were seen as quantum leaps. None was more revolutionary than when Dr Chris Barnard performed the world’s first human heart transplant in 1967.

During this time, the best interests of patients was always taken into account; but as Professor Lizo Mazwai, Chair of the Office of Standards and Compliance at the Department of Health, pointed out at the recent Discovery Health Quality Summit, the world has drifted away from this. “We have unfortunately lost our way and do not know what patient centred care means in the twentieth century,” said Mazwai.

Enter the patient

Mazwai pointed out that the patient of the twentieth century must first be seen as a human being, and thereafter as a patient.

“By nature, human beings are self-actualising, self-realising, self-fulfilling and self-determining. The status of being a patient should not remove or in any way diminish this right to self-determination,” said Mazwai.

In South Africa, this is entrenched in the Principles of Batho Pele, which was a movement started by the Nelson Mandela administration to improve service delivery and to eradicate corruption in government.

It is also spelt out in the Patient’s Rights Charter which says, among others, that:

-               every patient has a right to participate in decision making;

-               every patient has a right to a choice of health services;

-               every patient has a right to a second opinion;

-               every patient has a right to informed consent and;

-               every patient has a right to the refusal of treatment. 

But Mazwai says that at times we even fall short on this. “Whereas in the past, the care of patients was always orientated for the benefit of the patient, there is very little participation by the patient in the involvement in decision making,” said Mazwai. 

An educated point of view

“One of the provisions in the Patient’s Rights Charter says that every patient has a right to a second opinion. This may put the doctor on the back foot because they may feel that because they have studied and practiced in the industry for so long, a second opinion is not needed. However, when one considers life changing procedures such as surgery that deals with cancer or bypass surgery; the patient must have control of this decision,” said Mazwai. 

“Another provision that is key to focus on is the right to refusal of treatment. A person may refuse treatment and such refusal shall be verbal or in writing, provided that

such refusal does not endanger the health of others. The healthcare professional also has the right to ask why they are refusing treatment. If it is because of a fear of associated risks or cultural reasons, the healthcare professional needs to sit with them and explain the process in full. If treatment is then still refused, they can indicate as such,” said Mazwai. 

Are we serious?

If we take the above into consideration, we need to ask if patient centred care is more rhetoric than reality. 

Dr Roshini Moodley Naidoo, Head of Clinical Quality Management at Discovery Health, says that this is not the case. “Patient centred care is not an unreachable goal, sometimes the intricacy of healthcare systems around the world gives the impression that this is an unachievable goal. However, there are many doctors and nurses in the country that have an ingrained need to show human compassion. These are the stories we need to tell,” said Moodley Naidoo. 

Professor Carol Benn, Specialist Surgeon and Head of the Helen Joseph and Netcare Breast Care Centre, pointed out that we must clearly define what we mean when we refer to patient centred care. “If we are referring to patient centred care, does that mean that the patient is in the middle of the care process, does it mean that the patient leads the care process, or does it mean that the patient plays an important role in the decision making process?

Editor’s Thoughts:
This is a maxim that should be worked towards in all hospitals around the world. However, the reality is that hospitals in South Africa are often understaffed and the doctor to patient ratio may not allow for the level of patient centred care that we are expecting. Perhaps we need to re-evaluate our own expectations? Please comment below, interact with us on Twitter at @fanews_online or email me your thoughts jonathan@fanews.co.za.

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