Patient-Centred Care

By
Dr. Besigye Kabahena Innocent
MBChB, Mmed (Family Medicine)
 PCC
“a philosophy of care that encourages”…..
•Shared control of the consultation and decisions about
management of the health problem(s) with the patient,
and / or
•In the consultation; a focus on the patient as a whole who
has individual preferences situated within a social context
– Vs. a focus in the consultation on a body system /body part
or disease
 Components
– Exploring both the disease and the illness
experience;
– Holistic understanding of the person (i.e. clinical,
individual, contextual);
– Establishing common ground (patient
participation);
– Building a personal clinician-patient relationship.
 Patient’s Perspective
• Feelings
• Ideas
• Concerns
• Expectations
 Component 1: Exploring Health,
Disease & Illness
• Explore meaning of health
- Being physically active
- Being involved with my family
• Patient’s response to illness/illness experience
- Feelings (sadness about losses & limitations
- Fears of recurrence
- Concerns about well again to participate in daily
life activities
• Ideas
- Blames e.g poor diet, not exercising,
overweight etc
- Other associated issues e.g weakness
• Fears
-Not able to work full time again
- Sexual activity
- Loss of job
• Expectations
- Advice on how to recover/live with the
disease
- Order for an investigation
- Prescribe medication
- How to avoid recurrence
Component 2: Understanding the
Whole Person
• Individual & family
Note: It is impossible to practice effective
medicine without attention to the range
psychological & social issues embedded in the
lives of human beings
• Life cycle changes
• Context: Proximal & Distal
 Component 3: Finding Common
Ground
• Define the problem (most patients want a
name/label for their disease to help them gain
control over what is happening to them)
• Define the goals and priorities of treatment
• Define the roles of patient and clinician
 Component 4: Enhancing the
Doctor-Patient Relationship
“the greatest challenge facing contemporary
medicine is fir it to retain ….or regain its
humanity without loosing its essential
foundation in science…to find a middle way”
 Requirements
• Compassion
• Caring
• Empathy
• Trust
 Practice of PCC
Exploring both the illness & disease

•Illness is the patient’s personal experience of symptoms, feelings and

discomforts

•Disease is the medical explanation given for any health problem

•Patients’ agenda - Having their concerns & expectations regarding illness

addressed (patient satisfaction)

•Dr’s agenda - To recognise a disease make a diagnosis & to address patient’s

agenda
 Consultation
Patient presents problem

Doctor Gathers Information

Parallel search of 2
frameworks
Illness Framework Disease Framework
(Patient’s agenda) (Doctor’s agenda)
Ideas Concerns History - symptoms
Expectations Feelings Examination - signs
Thoughts Effects Investigations
Understanding the Integration of
patient’s the two
experience of the Underlying
frameworks pathology
unique illness
Differential
Explanation and planning : diagnosis
Shared understanding and
decision making
Thank You