Qudsia Anjum  ( Consultant Family Medicine, International Medical Center, Satellite Clinic, Saudia Arabia. )

Health care has evidenced many evolutions; however, the core of efforts to improve well being of individuals is the concept of patient centered care. This has been talked of in literature to a great extent; it is becoming widely used, but poorly understood in medicine. It can be defined as focusing on patient and individual\'s particular health care needs, incorporating patient\'s view points and perspectives into management of his/her illness. By virtue of this, patients are empowered to actively participate in their care.¹ If we integrate the definition of health as physical, mental and social well being into this concept, it becomes more enhancing. Using this amalgamation, we move beyond the pathophysiological model of disease and explore the biological, psychological and social aspects of the patient\'s illness.
Medical literature and research has considered patient centered care as professional evolution and shift from historic basis of health care.¹ It has been observed that through physician centered care, only physician takes the lead in decision making for the patient. They fail to address patients\' concerns, assess patients\' beliefs and understanding of their illness, and often do not share management options.Involving patients into their care makes them feel they are part of the management, making the consultation more fruitful. Practicing patient centered care enables the patient to understand his/her disease well and is capable to cope with it in a better manner. Advances in medicine and accessible information freely available over internet, is giving patients knowledge, which in many circumstances is not well understood, making it confusing for the patient. Concentrating in building the patients\' confidence in comprehending the vague ideas they have regarding illness will help in improved and effective management.
Berwick proposed a new definition of patient centered care: "The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one\'s person, circumstances, and relationships in health care".³ Research has identified six components of patient centered care: exploring the patient and expectation of disease and illness, understanding the whole person, finding common ground on management, health promotion, enhancing doctor-patient relationship and realistic use of time.⁴
Adding to this concept is the role of the family in patient centered care because the family is an integral part of every individual. This stands true when chronic diseases are considered, and now the universe is seeing not only transition but a double burden of diseases. A qualitative survey addressed family-centered diabetes self-management interventions with a focus on communication with families.⁵ A case report of a diabetic child used the patient centered approach for management, and it proved to be successful in self management, improved glucose control and quality of life.⁶ It is important to honour the strengths, culture and traditions which the family experiences, especially when it comes to minors, where the main decision maker are parents or care takers. The American Academy of Paediatrics made recommendations to encourage presence of family with the child receiving treatment in the emergency department.⁷ An observational study revealed that patient centered care brought the patient and physician on a common ground and increased the efficacy of care by reducing diagnostic tests and referrals.⁸ Another study evaluated that only one third of primary care physicians adopted patient centered approach in their practice.⁹ Considering stroke patients, they are unable to take care for themselves, and it is the family who is responsible for giving adequate care to post stroke patients. A recent qualitative analysis revealed that communication with the family is the key to better management.¹⁰
A recent letter to editor has highlighted the advantage of patient centered care in intensive care unit of one of the biggest tertiary care hospital in Pakistan.¹¹ This approach has made accomplishment with early recovery of the patient along with satisfaction of the family.¹¹ Another article from Pakistan has also claimed patient centered approach in pain management to be an attainable strategy for better outcomes.¹² This indicates there is growing concerns about this concept in the country, awareness exists, and implementation is awaited.
It\'s been debated that patients may not prefer "patient centered approach", and therefore, its universal adoption may not be wise. The misconception to be cleared with this regard is that patient centered does not mean sharing all information and decisions about the disease. In actual, it means patients desire for information and sharing in decision making with an appropriate response. This has been reinforced in an observational study that expressed three important domains of patient centered approach are communication, partnership and health promotion.¹³
Patient centered care is a notion that should be applied to all areas of medicine, patient care, health related law, medical education, research and quality assessment. Patient centered care along with family involvement can be regarded as a holistic approach with patient-doctor interaction in a distinctive manner.

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13. Little P,  Everitt H, Williamson I, Warner G,  Moore M, Gould C, et al. Preferences of patients for patient centered approach to consultation in primary care: observational study. BMJ 2001; 322: 284-468.