Twenty years on - has patient-centered care been equally well integrated among medical specialties?

The concept of 'patient-centered care' was touted as a pillar of good clinical practice and endorsed by the US Institute of Medicine in a seminal 2001 publication. We explore the extent to which differing medical specialties have engaged with the concept over the last 20 years and how and why this attention has varied among a sample of medical specialties since 2001.

Reference to patient-centered care in the medical literature for selected specialties was used as a proxy for clinical application of patient-centered care in those disciplines. We undertook a statistical analysis and historical review of the medical literature that references the concept of patient-centered care in pediatrics, obstetrics and gynecology (OB-GYN), orthopedics, radiology, dermatology, and neurosurgery. We analyzed the extent to which the literature referencing patient-centered care has changed for the six disciplines since first mentioned in the Institute of Medicine 2001 publication. We measured changes over time in reference to patient-centered care in the medical literature for the six diverse medical specialties.

The six disciplines differed significantly in reference to patient-centered care when comparing publications between the disciplines (p < 0.001). Pediatrics showed the most extensive reference to the concept followed by OB-GYN. In contrast, patient-centered care was hardly mentioned in dermatology and neurosurgery, nor orthopedics or radiology. When correcting for the number of papers published in the different fields, reference to patient-centered care is ~18X more common in pediatrics than in neurosurgery.

Uptake, attention, and applicability of the principles of patient-centered care have varied over the last 20 years. Differences among specialties appear to reflect true differences in patient centricities in the disciplines, with higher uptake in specialties that are person-oriented rather than technique-oriented. Greater engagement with patient-centered care correlates strongly with the number of female physicians in each field.