A talk given on October 20, 2013, at the National Physician Alliance 2013 Annual Meeting, Washington, DC.

1. Patient-Centered Care in a DoctorCentered System
Or: Searching for the Squircle
Zackary Berger, MD, PhD
Johns Hopkins General Internal Medicine
http://talkingtoyourdoctor.org
National Physicians Alliance 2013 Annual Meeting

2. What is patient-centered care?
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6. What is patient-centered care?
• A philosophy
– Patients are what matters most about any
health care encounter
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An approach to quality improvement
A recipe for care delivery
An ethical requirement
A priority for health care reform

7. What are the characteristics of a
doctor-centered system?
Doctors are…
• At the center of every encounter
• The most common subject of quality
improvement efforts
• The essential nexus of care delivery
• The engine of health care reform
• A frequent object of ethical concern

9. How to square the circle?
Some common proposals
• Place patients at the center!
– Patients are people
– People can make their own decisions
• Decentralize care!
– Care should be available in multiple
formats, multiple settings
– The promise of Big Data
• Centralize care!
– Doctors: heads of patient-centered teams

11. Pursuing the Squircle: Doctor-Patient
Partnership
• Not (just) patient-centered care
– This is a laudable goal but does not adress
all questions
• Not just shared decision making
– Not all encounters involve decisions
– Not all patients wish to share in decisions
• Not all patients wish to participate in
team-based care

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13. Optimizing the Relationship:
A Research Agenda
• The PCP-patient relationship:
characteristics, experiences, and
outcomes
– How do we define it?
– Does it matter?
– Does it mean better care?
– Can we improve it?
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14. Optimizing the Relationship:
A Clinical Agenda
• Improving and utilizing the PCP-patient
relationship for improving outcomes
– Can the PCP be preserved as part of the
medical home?
– How can we clarify specialist and
generalist roles?
– How relevant, or modifiable, is the
“gatekeeper” function?
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15. Optimizing the Relationship:
An Advocacy Agenda
• Realigning our system and its incentives
to promote the PCP-patient relationship
– Changing the payment structure
– Incentivizing primary care education
– Equalizing involvement for all primary care
providers, e.g. NPs
– Reshaping a culture of overuse
– Redefining high quality care
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17. Questions, comments, or
ways to square the circle?
Zackary Berger, MD, PhD
(zberger1@jhmi.edu)
http://talkingtoyourdoctor.org
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