Why I shudder when I hear the term ‘person centred care’


When I was doing my junior medical rotations, in preparation for the clinical examinations for the Royal Colleges of Physicians, there would always be the scary assessment of ‘communication skills’.

This is long before the time of the current #mynameis campaign in the NHS.

Having introduced yourself to the patient, one of the first things you’d be examined on is your exploration of the patient’s “beliefs, concerns and expectations.” The aim of the medical consultation was to prepare a management plan, given the time constraints, given these aspirations from the patient.

In reality, we all know the nonsense of being able to deal with all of a patient’s issues within a ten minute timeframe. People living with conditions, such as dementia, have had long time to reflect on the nature of their conditions and how impact on their lives.

The power imbalance in the doctor-patient relationship, I do not wish to deny, can potentially be a problem. For an example a medical patient’s wish to ‘live better with dementia’ can easily become a GP’s wish to solve a problem (s)he thinks (s)he can solve – like a modest improvement of memory through a drug.

For example, I violently object to Doctors seeing people as nameless entities, with no background, simply as a list of medical problems.

In life, I believe strongly we should actively seek out what people can do too.

Ultimately, I feel we are all persons, and that we become patients when we become ill. I think personhood is all about embracing a person’s past and present, and his or her relationships with everyone else; this should have been an aim of healthcare professionals all along.

I happen to be proud of being  a ‘Dr’ only because I endured (so I perceived) quite a lot of stigma from being banned from the Medical Register during my problems consequent upon alcohol abuse. In fact, I deliberately avoided calling myself ‘Dr’ even though I knew I was perfectly entitled to, on the grounds of having completed a doctor of philosophy (“a real Doctorate”).

In hospitals, it can be useful also to be a ‘Dr’ to save a lot of time. I am only saying this as I have seen circular discussions on ‘abolishing hierarchies’ in the “new model NHS”, and I can say for a fact that I never had an ‘attitude’ from being any sort of Doctor. In hospitals, it can be useful for patients to differentiate yourself from other health professionals.

With being a Doctor comes a lot of baggage too, like always being on best behaviour 24/7 outside of your job, or not giving any advice to complete strangers despite people asking for advice. That is, rather, an honour of professional regulation.

But I feel that the term ‘person centred care’ requires explanation. If it is not patient centred, what else is the healthcare system revolved around?

It could be “relationships” centred, and this takes away the rather individualistic approach. Or it could be “family centred”, in that you can make decisions jointly and severally with whole families. But no terms are ideal – some people can have few relationships, and/or no family.

However you define ‘person centred care’, it is not only liable to being a bandwagon, but liable to be a performance reductionist metric imposed by non-professionals on professions to ‘improve quality’, when the whole world knows that many healthcare professionals desire time, space and resources do the job.

When I chat with a friend of mine living with dementia I do not see as ‘person centred care’, merely just being a good support hopefully. Likewise, if we have ‘dementia friendly communities’, I genuinely wonder who else we are being friendly or unfriendly to.

It’s become dreadfully easy for ‘person centred care’ to trip off the tongue.

But a few basic ‘messages’ somehow appear to have become drowned out – such as health and wellbeing not merely the absence of illness.

Kate Swaffer once joked about ‘purse centred care’ in a now seminal article “There is Big Money in dementia” (click here).

And after all you can set your criteria for your brand of purse centred care is like, trademark it, flog it; but this would defeat the whole ethos of the intentions of the work of Tom Kitwood.

Whatever “person centred care” is to managers or others, we don’t seem to be doing a good job in achieving it according to the Health Foundation. We all have different takes on the notion. As with anything else, I suspect, however, too many cooks spoil the broth.