Good Practice: Applying Autonomy and Patient-Centered Care to Daily Practice

  •   August 27, 2014

These days, the terms patient autonomy and patient-centered care are everywhere. It is important that health professionals have a firm grasp of what these terms mean and how they apply to their daily work. The concept of autonomy relates to the patient’s ability to choose what is in his or her best interest and to direct their own care. Patient-centered care (or client-centered service) is defined in the Standards of Practice1 and exemplified by the following:

  • Demonstrating respect for the client.
  • Valuing the client’s best interest.
  • Explaining how the services offered will meet the patient’s needs and desired outcomes.
  • Supporting client participation and choice about the services offered, including the choice to refuse services.1

A common misperception is that patients have the right to get what they ask for without a cautious review of what is actually appropriate. As we can see from the Standards of Practice, patient-centered care is about offering services that will help the patient reach their desired outcomes, not about providing any service the patient demands. As Epstein and Street (2011) state, the patient’s “wishes are honored (but not mindlessly enacted), during their health-care journey.”2

“A doctor who acquiesces to a patient’s request for unnecessary antibiotics may have a happy patient, yet inappropriate prescribing could hardly be called patient-centered care.”2 The same can be said of the physiotherapist providing cervical manipulation to the person with rheumatoid arthritis, prophylactic chest physiotherapy to the COPD patient, or daily full body IMS to the chronic pain patient.

As a profession, it is important that we consider not only what the patient desires but also what is appropriate. Conversations about patient care should revolve around what the patient’s desired outcome is, rather than which tool in your professional skill set you will use to achieve that outcome. 

Your role as a physiotherapist encompasses the same responsibilities it always has:

  1. Assess your patient.
  2. Establish a proposed plan of care based on the findings of that assessment.
  3. Discuss your findings and your plan of care with the patient.
  4. Discuss and set goals with your patient regarding their desired treatment outcomes.
  5. Educate your patient on the treatment techniques you are suggesting and the evidence that supports their use. If the treatment you are offering is not the one they are seeking, a clear explanation of why not is in order.
  6. Come to an agreement with your patient of how you will proceed. This includes a discussion of whether the patient chooses to follow your proposed treatment plan or not.

Respecting a patient’s decision not to follow a proposed plan of care rests firmly on the foundation of patient-centered care and respect for autonomy. The patient may choose to seek treatment elsewhere, or you and your patient may collaborate to determine a plan of care.

It is critical that professionals provide appropriate care. Patient-centered care does not, nor has it ever meant that professionals provide care that is not evidence-based and/or consistent with best practices just because the patient asked for it. When pressured to do so the professional has an obligation to reflect on best practice and the Standards of Practice and act accordingly.


References:

  1. Physiotherapy Alberta - College + Association. Standards of Practice for Alberta Physiotherapists. 2012. http://www.physiotherapyalberta.ca/files/practice_standards_all_2012_revised.pdf
  2. Epstein RM, Street RL. The values and value of patient-centered care. Annals of Family Medicine [Internet]. 2011 Mar/Apr; 9(2)  Available from: http://www.annfammed.org/content/9/2/100.full.pdf+html