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Searching for the Squircle: Patient-Centered Care in a Doctor-Centered System
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Searching for the Squircle: Patient-Centered Care in a Doctor-Centered System

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

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


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  • 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? 10/21/2013 2
  • 3. What is patient-centered care? • A philosophy – Patients are what matters most about any health care encounter • • • • An approach to quality improvement A recipe for care delivery An ethical requirement A priority for health care reform
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. 10/21/2013 12
  • 8. 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? 10/21/2013 13
  • 9. 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? 10/21/2013 14
  • 10. 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 10/21/2013 15
  • 11. 10/21/2013 16
  • 12. Questions, comments, or ways to square the circle? Zackary Berger, MD, PhD (zberger1@jhmi.edu) http://talkingtoyourdoctor.org 10/21/2013 17