Letter - Response to 'Is patient-centred care a tautology?'

There are often many interpretations of patient-centred care. The plethora of information at a patients disposal coupled with current financial strictures, highlights the importance of the concept of patient-centred care and its place in providing evidence based medicine that is cost-effective.Many PCTs and hospitals have and continue to place increasing restrictions in various aspects of health care; screening tests, for example, cervical smear, pathological and radiological investigations, not to mention the proliferation of referral management schemes. All these are directed, it seems, towards improving care, containing costs, and hopefully enriching the patient experience. Whether these various attributes are ever reconcilable is a matter of dispute and interest. However, it would seem prudent to consider patient-centred care as a consideration of a patient's likes/dislikes and views in the light of the available facilities. This places upon the doctors the need to describe and discuss the restrictions in place, and the options available within those restrictions, with as full a disclosure of relevant information as possible. This would then enable the patient to make an informed choice. The doctor serves as the source of information and the director in encouraging, without coercion, the patient towards the most appropriate choice.Too often patient-centred care is also confused with the exercise of autonomy by the patient. Respect for autonomy is often taken to mean acceding to the request of a patient. On the contrary, autonomy is best viewed as an expression of choice by an informed patient. Choice in this case would be one from the available options at the time, currently this would entail a discussion of cost and clinical effectiveness within the parameters of availability.Now, one could argue that this is whatdoctors should always have been doing. One benefit of the current restrictions is to return doctors to their professional roots and to encourage evaluation of the scope of care with patients.In both these scenarios doctors would be required to address the perennial issue of needs versus wants and their own professionalism.