You hear a lot these days about ‘patient centered care’ as the health system (on paper at least) moves away from the old disease-centered model that would base treatment decisions largely on the physician or nurses previous clinical experience in response to objective data from various tests and assessments.
The patients role would be passive. The diagnoses of their illness or disease would be ‘extracted’ from them and then the treatment would be imposed upon them.

With the newer model of patient centred care, the patient is empowered to participate much more collaboratively in their care.
It is described as a partnership, where the assessment and diagnosis is explained to the patient and their feelings, beliefs and expectations are listened to and explored by the health-care team. Once fully informed, the patients decision-making is respected (even if the patient decides to take risks or move against accepted management guidelines).

Evidence has shown that patient centered care increases patient satisfaction, improves quality of life, and increases positive health outcomes.

But there is still something missing here.
Whilst there is a much improved flow of information back and forwards between the patient, their families, and the medical staff, and (at least superficially) there seems to be a much stronger collaborative approach to the problems, perhaps in some respects a patient centred model is binding care delivery just as much as the disease centred model.

Off-Centred Care.

In these days of high workloads, a complex structuring of the medical specialties into silos, shortages of medical staff and emphasis on increased productivity (doing ever more…with ever less), doctors, nurses and other healthcare professionals are placed under extraordinary levels of personal and inter-personal stress.
What is often left unacknowledged is the profound effects on patient care outcomes that can result from professional dissatisfaction, physical and mental exhaustion, and any degree of ethical or spiritual dislocation being experienced by the care-givers.

Many many times I have seen all the empowerments of patient centered care and evidence based practice and best practice guidelines trumped by the disempowering actions of an exhausted doctor, or an unhappy nurse, or a depressed manager or a disinterested executive (aside: is evidence based practice actually evidence based anyway?).

Encompassing Care Delivery.

Instead, the focus should be not on the patient, not on the disease, not even on the care-givers, but rather on the field of relationship between them.
No centre at all really, but rather a system of Encompassing Care Delivery (ECD).
For example: ECD would consider the relational effects of the nurse on the patient as well as the patient on the nurse (as well as the patient/nurse relationship on the doctor and vice-versa and etc).
The focus would shift to improving the quality of what happens in the space between the patient and the care-givers be it physical interventions, communications, personal development, or problems. ECD would concentrate on providing tools for the patient, the staff and the so called ‘significant others’ to interact with an increased quality.
Such variables as the environment, staff workloads, debriefing, mentorship, mindfulness, intimacy of care delivery would be seen as important to the healing process as antibiotics and CAT scans .

Professional objectivity would be validated as the thin veneer that is actually inhabits, and deep exploration of the inter-subjectivity’s between all members of the health care team would be encouraged. A sort of therapy going into therapy?
Care for the staff and care for the patient would be seen as two sides of the same coin and evidence based would be just one aspect of delivering quality based care.