Book Review

Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care

N Engl J Med 1994; 330:873March 24, 1994

Article

Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care
Edited by Margaret Gerteis, Susan Edgman-Levitan, Jennifer Daley, and Thomas L. Delbanco. 317 pp. San Francisco, Jossey-Bass, 1993. $29.95. ISBN: 0-1-55542-544-5

The practice of “patient-centered” or “biopsychosocial” care, long championed by Ian McWhinney and George Engel, rests on two basic principles. First, medical care must be firmly grounded in the patient's subjective experience of illness; to deal only with objectively defined phenomena such as ventricular function or creatinine clearance is not enough. Second, the patient and clinician must be collaborators, sharing responsibility for defining goals and problems, making decisions, and carrying out treatment plans.

To date, nearly all the discussion of patient-centered care has focused on the patient-clinician dyad. Through the Patient's Eyes moves this discussion to the level of medical institutions, with very worthwhile results. It shows us what patient-centered hospitals might look like and demonstrates that “institutional” does not have to be synonymous with “impersonal.” The book summarizes the results of five years of work by the Picker-Commonwealth Program for Patient-Centered Care. Drawing on focus groups, survey data, site visits, and literature reviews, the authors describe problems and suggest solutions in seven areas of patient-centered care: respecting patients' values and preferences; coordinating care; providing information and education; attending to physical comfort; providing emotional support; involving family and friends in care; and ensuring continuity among providers and treatment settings. The authors amply illustrate the ways in which the organization and procedures of hospitals lead well-intentioned professionals and staff members to neglect, insult, and otherwise dehumanize patients. The practical suggestions range from bulletin boards at each bedside for questions or messages to educational videotapes on post-hospital care to the breakdown of rigid divisions of labor among ward staff.

This book should be useful to hospital administrators, managers, department heads, policy makers, and practitioners -- anyone who is responsible for planning or overseeing patient care. It will be especially helpful to readers who are unfamiliar with the concept of patient-centered care. Readers with more experience in this area may find some of the chapters too basic, and there will be many surprising omissions from the literature reviews (the work of Engel and McWhinney, for example). Nevertheless, Through the Patient's Eyes contains a wealth of practical ideas and breaks important ground in making medical institutions more responsive to patients' needs.

Creating patient-centered hospitals will require more than just adopting the policies and programs described in the book, as the authors readily acknowledge. A new institutional culture must be nurtured in which relationship and partnership are valued more than control, and in which subjective experience is taken as seriously as more traditional objective data. Achieving this goal will require better communication and interpersonal skills on everyone's part. We will also need methods for “person-centered administration” that parallel those of patient-centered care. The values must run true throughout the organization; we are most likely to treat others the way we ourselves are treated.

The authors challenge their readers to do better at providing humane care in hospitals. Their book will be a valuable resource in getting started.

Anthony L. Suchman, M.D.
Highland Hospital, Rochester, NY 14620