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Expanding The Rubric of “Patient-Centered Care” (PCC) to “Patient and Professional Centered Care” (PPCC) to Enhance Provider Well-Being

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Abstract

Burnout among physicians, nurses, and students is a serious problem in U.S. healthcare that reflects inattentive management practices, outmoded images of the “good” provider as selflessly ignoring the care of the self, and an overarching rubric of Patient Centered Care (PCC) that leaves professional self-care out of the equation. We ask herein if expanding PCC to Patient and Professional Centered Care (PPCC) would be a useful idea to make provider self-care an explicit part of mission statements, a major part of management strategies and institutional goal setting, and of educational programs. We offer several practical suggestions for PPCC implementation, including structuring healthcare systems so as to nurture professional meaning, integrity, and inter-personal reflective emotional processing as a buffer against burnout and as a key to better patient care. It should not bring into question the primacy of practitioner commitment to the good of patients, nor should it be taken to suggest in any way a shift in focus away from patients’ values and respect for patient autonomy. PPCC asserts that the respect for patient’s values and autonomous choices properly remains the ethical benchmark of modern healthcare systems, along with altruistic professional commitment to the optimal care of patients. However, it enunciates an explicit commitment to structuring systems that allow for and actively encourage the professional well-being and wellness upon which good patient care depends.

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References

  • Arnetz, B. B. (1997). Physicians’ view of their work environment and organization. Psychotherapy and Psychosomatics, 66, 155–162.

    Article  Google Scholar 

  • Brazeau, C. M., Shanafelt, T., Durning, S. J., Massie, F. S., Eacker, A., Moutier, C., et al. (2014). Distress among matriculating medical students relative to the general population. Academic Medicine, 89(11), 1520–1525.

    Article  Google Scholar 

  • Brock, C. D., & Stock, R. D. (1989). A survey of Balint group activities in US family practice residency programs. Family Medicine, 22(1), 33–37.

    Google Scholar 

  • Buchbinder, S. B., Wilson, M., Melick, C. F., & Powe, N. R. (1999). Estimates of costs of primary care physician turnover. American Journal of Managed Care, 5(11), 1431–1438.

    Google Scholar 

  • Buetow, S. (2011). Person-centred care: Bridging current models of the clinician-patient relationship. International Journal of Person Centered Medicine, 1(1), 196–203.

    Article  Google Scholar 

  • Campbell, D. A., Sonnad, S. S., Eckhauser, F. E., Campbell, K. K., & Greenfield, L. J. (2001). Burnout among American surgeons. Surgery, 130(4), 696–705.

    Article  Google Scholar 

  • Caplan AL. Physician burnout is a public health crisis, ethicist says. Medscape. http://www.medscape.com/viewarticle/859300. Retrieved 4 Mar 2016.

  • Christensen, J. F., Levinson, W., & Dunn, P. M. (1992). The heart of darkness: The impact of perceived mistakes on physicians. Journal of General Internal Medicine, 7, 424–431.

    Article  Google Scholar 

  • Dewa, C. S., Jacobs, P., Thanh, N. X., & Loong, D. (2014). An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. BMC Health Services Research, 14(1), 254.

    Article  Google Scholar 

  • DiMatteo, M. R., Sherbourne, C. D., Hays, R. D., Ordway, L., Kravitz, R. L., McGlynn, E. A., et al. (1993). Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the medical outcomes study. Health Psychology, 12(2), 93.

    Article  Google Scholar 

  • Dyrbye, L. N., Eacker, A., Durning, S. J., Brazeau, C., Moutier, C., Massie, F. S., et al. (2015). The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Academic Medicine, 90, 7961–7969.

    Google Scholar 

  • Dyrbye, L. N., Harper, W., Durning, S. J., Moutier, C., Thomas, M. R., Massie, F. S., Jr., et al. (2011). Patterns of distress in US medical students. Medical Teacher, 33(10), 834–839.

    Article  Google Scholar 

  • Dyrbye, L. N., Harper, W., Moutier, C., Durning, S. J., Power, D. V., Massie, F. S., et al. (2012). A multi-institutional study exploring the impact of positive mental health on medical students’ professionalism in an era of high burnout. Academic Medicine, 87(8), 1024–1031.

    Article  Google Scholar 

  • Fins, J. (2016). What’s wrong with evidence-based medicine? Hastings Center Report, 46(1), 2–48. 

    Article  Google Scholar 

  • Frankl, V. (1959). Man’s search for meaning. Boston: Beacon Press.

    Google Scholar 

  • Geurts, S., Rutte, C., & Peeters, M. (1999). Antecedents and consequences of work–home interference among medical residents. Social Science and Medicine, 48(9), 1135–1148.

    Article  Google Scholar 

  • Haas, J. S., Cook, E. F., Puopolo, A. L., Burstin, H. R., Cleary, P. D., & Brennan, T. A. (2000). Is the professional satisfaction of general internists associated with patient satisfaction? Journal of General Internal Medicine, 15(2), 122–128.

    Article  Google Scholar 

  • Halbesleben, J. R., & Rathert, C. (2008). Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Management Review, 33(1), 29–39.

    Article  Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. http://www.nap.edu/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the. Accessed 16 Mar 2016.

  • Irving, J. A., Dobkins, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary Therapies in Clinical Practice, 15(2), 61–66.

    Article  Google Scholar 

  • Jochemsen-van der Leeuw, H. G., van Dijk, N., van Etten-Jamaludin, F. S., & Wieringa-de Waard, M. (2013). The attributes of the clinical trainer as a role model: A systematic review. Academic Medicine, 88(1), 26–34.

    Article  Google Scholar 

  • Kash, K. M., Holland, J. C., Breitbart, W., Berenson, S., Dougherty, J., Ouellette-Kobasa, S., et al. (2000). Stress and burnout in oncology. Oncology., 14(11), 1621–1633.

    Google Scholar 

  • Katz, J. (2002). The silent world of doctor and patient. Baltimore: The Johns Hopkins University Press.

    Google Scholar 

  • Leiter, M. P., Harvie, P., & Frizzell, C. (1998). The correspondence of patient satisfaction and nurse burnout. Social Science and Medicine, 47(10), 1611–1617.

    Article  Google Scholar 

  • Linn, L. S., Brook, R. H., Clark, V. A., Davies, A. R., Fink, A., & Kosecoff, J. (1985). Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Medical Care, 1, 1171–1178.

    Article  Google Scholar 

  • Lown, B. A., & Manning, C. F. (2010). The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Academic Medicine, 85(6), 1073–1081.

    Article  Google Scholar 

  • Ludwig, D. S., & Kabat-Zinn, J. (2008). Mindfulness in medicine. JAMA, 300(11), 1350–1352.

    Article  Google Scholar 

  • Maslack, C., Jackson, S. E., & Letter, M. P. (1996). Maslack burnout inventory manual. Palo Alto: Consulting Psychologists Press.

    Google Scholar 

  • McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2), 202–210.

    Article  Google Scholar 

  • McMurray, J. E., Linzer, M., Konrad, T. R., Douglas, J., Shugerman, R., & Nelson, K. (2000). The work lives of women physicians. Journal of General Internal Medicine, 15(6), 372–380.

    Google Scholar 

  • Melville, A. (1980). Job satisfaction in general practice implications for prescribing. Social Science and Medicine, 14(6), 495–499.

    Google Scholar 

  • Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009.

    Article  Google Scholar 

  • Peckham, C. (2015). Medscape family physician lifestyle report 2015. Medscapehttp://www.medscape.com/features/slideshow/lifestyle/2015/public/overview. Accessed 16 Mar 2016. 

  • Post, S. G. (2011). Compassionate care enhancement: Benefits and outcomes. International Journal of Person Centered Medicine, 1(4), 808–813.

    Google Scholar 

  • Rabow, M. W., & McPhee, S. J. (2001). Doctoring to heal: Fostering well-being among physicians through personal reflection. Western Journal of Medicine, 174(1), 66.

    Article  Google Scholar 

  • Schulte, B. (2015). Time in the bank: A Stanford plan to save doctors from burnout. Washington Post. https://www.washingtonpost.com/news/inspired-life/wp/2015/08/20/the-innovative-stanford-program-thats-saving-emergency-room-doctors-from-burnout/

  • Shabiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12(2), 164–176.

    Article  Google Scholar 

  • Shanafelt, T. D. (2009). Enhancing meaning in work: A prescription for preventing physician burnout and promoting patient-centered care. JAMA, 302(12), 1338–1340.

    Article  Google Scholar 

  • Shanafelt, T. D., Balch, C. M., Bechamps, G. J., Russell, T., Dyrbye, L., Satele, D., et al. (2009a). Burnout and career satisfaction among American surgeons. Annals of Surgery, 250(3), 463–471.

    Google Scholar 

  • Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., et al. (2012a). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377–1385.

    Article  Google Scholar 

  • Shanafelt, T. D., Bradley, K. A., Wipf, J. E., & Back, A. L. (2002). Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine, 136(5), 358–367.

    Article  Google Scholar 

  • Shanafelt, T. D., Gorringe, G., Menaker, R., Storz, K. A., Reeves, D., Buskirk, S. J., et al. (2015). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432–440.

    Article  Google Scholar 

  • Shanafelt, T. D., Oreskovich, M. R., Dyrbye, L. N., Satele, D. V., Hanks, J. B., Sloan, J. A., et al. (2012b). Avoiding burnout: The personal health habits and wellness practices of US surgeons. Annals of Surgery, 255(4), 625–633.

    Article  Google Scholar 

  • Shanafelt, T. D., West, C. P., Sloan, J. A., Novotny, P. J., Poland, G. A., Menaker, R., et al. (2009b). Career fit and burnout among academic faculty. Archives of Internal Medicine, 169(10), 990–995.

    Article  Google Scholar 

  • Shem S. (2003) The House of God. New York, NY: Delta Trade Paperbacks.

  • Slavin, S. L. (2016). Medical student mental health: Culture, environment, and the need for change. JAMA, 316(21), 2195–2196.

    Article  Google Scholar 

  • Stoddard, J. J., Hargraves, J. L., Reed, M., & Vratil, A. (2001). Managed care, professional autonomy, and income: Effects on physician career satisfaction. Journal of General Internal Medicine, 16, 675–684.

    Article  Google Scholar 

  • Warde, C. M., Moonesinghe, K., Allen, W., & Gelberg, L. (1999). Marital and parental satisfaction of married physicians with children. Journal of General Internal Medicine, 14(3), 157–165.

    Article  Google Scholar 

  • West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet, 388(5), 2272–2281.

    Article  Google Scholar 

  • West, C. P., Dyrbye, L. N., Rabatin, J. T., Call, T. G., Davidson, J. H., Multari, A., et al. (2014). Intervention to promote physician well-being, job satisfaction, and professionalism: A randomized clinical trial. JAMA internal medicine, 174(4), 527–533.

    Article  Google Scholar 

  • West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., et al. (2006). Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA, 296(9), 1071–1078.

    Article  Google Scholar 

  • West, C. P., Shanafelt, T. D., & Kolars, J. C. (2011). Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA, 306(9), 952–960.

    Article  Google Scholar 

  • Wyer, P. C., Silva, S. A., Post, S. G., & Quinlan, P. (2014). Relationship centered care: Antidote, guidepost or blind alley. Journal of Evaluation in Clinical Practice, 20, 881–889.

    Article  Google Scholar 

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Post, S.G., Roess, M. Expanding The Rubric of “Patient-Centered Care” (PCC) to “Patient and Professional Centered Care” (PPCC) to Enhance Provider Well-Being. HEC Forum 29, 293–302 (2017). https://doi.org/10.1007/s10730-017-9322-7

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