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LEARNING OBJECTIVES

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  1. To define patient-centered care.

  2. To explain the importance of patient-centered care as a primary component of medical professionalism.

  3. To outline the behaviors and skills needed to demonstrate caring and to build trust.

  4. To describe the behaviors and skills needed to conduct informed decision-making conversations.

  5. To explain the role individual physicians, healthcare teams, the healthcare setting, and the external environment play in fostering the delivery of patient-centered care.

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INTRODUCTION

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John and Helen are 65 years old and have been married for 30 years. Recently they were recounting to a friend their vivid memories of the day Dr. Owen, an oncologist, told Helen that she had breast cancer. Although this event took place 20 years ago when Helen was 45 years old, both of them remember in great detail the visit with Dr. Owen when he broke the news. What Helen remembers most is how he told her he had bad news but he was going to be with her every moment of the journey ahead—that she was going to be okay. She remembers him holding her hand when she cried. She remembers the silence in the room that hung there for what seemed like a long time while she sobbed and couldn't speak. She remembers the warmth in his voice when he said, “I am so sorry you have to deal with this.”

John remembers similar moments, and he also recalls how Dr. Owen checked to see how he was feeling. He remembers how Dr. Owen answered his questions about the next steps in the work-up and the possible treatment options (Helen doesn't remember that part of the conversation at all). John remembers that he called Dr. Owen later the same day to clarify a question and that Dr. Owen called back at 8 pm and addressed his concerns. John and Helen told their friend how much Dr. Owen meant to them over the next years of treatment and that even though Helen does not need him anymore they will always remember how much he cared.

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Medical care ideally is delivered by caring professionals who are seeking to meet patients' physical, psychological, and social needs. Patients and families all want a physician like Dr. Owen who demonstrates compassion in times of stress and who helps them to understand the complex and confusing world of healthcare. Although we feel comfortable in medical settings, the medical environment can be a scary, overwhelming, and sometimes intimidating place for patients. Despite our best intentions, we sometimes forget what it feels like to be a patient. Many patients do not feel that they have encountered a physician like Dr. Owen.

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Excellent medical care combines sophistication in scientific knowledge with equally sophisticated communication skills to understand the needs of patients, to address their emotions, and to educate patients about their choices in care. These communication skills underpin our ability to deliver “patient-centered care”—the term used ...

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