Don’t Ignore the Patients

Over 90% of the daily long-term treatment of most chronic conditions is carried out by patients themselves in their own homes. Consequently, patients must be recognized and accepted as legitimate members of the health care team, with all of the associated rights and responsibilities. Chronic illnesses will, both now and in the foreseeable future, continue to be our nation’s leading causes of death, disability, and medical expenditures, and as such, they will demand a delivery system responsive to their unique needs and to patient involvement.

The Institute of Medicine’s (IOM’s) Committee on Quality of Health Care in America recently published Crossing the Quality Chasm: A New Health System for the 21st Century (1). This publication will undoubtedly have a tremendous impact on the future of health care in this nation. The conclusions reached indicate the need for “fundamental changes” and declared “health care must be: safe, effective, patient-centered (providing care that is respectful of, and responsive to, individual preferences), timely, efficient and equitable.” Unfortunately, the role and responsibilities of patients in this report were grossly neglected, and references were repeatedly made to “patients receiving care” or to the system “serving” or “providing patients with.” These inferences tend to perpetuate the existing paternalistic acute care system, which relies on activated health professionals providing care to a passive patient population.

Health maintenance, chronic disease prevention, and long-term treatment are largely the responsibility of patients themselves, and it is imperative that this concept be acknowledged, developed, and implemented as soon as possible. The IOM publication failed to advocate this concept. Currently, there is considerable interest in “patients’ rights,” which is a step in the right direction, but this must be accompanied simultaneously by an effort to define and legislate “patient responsibilities.”

Health care for the 21st century must use a systems-approach directed at the prevention and treatment of chronic illnesses that is scientifically based, cost-effective, and patient-oriented (2). These demands vary widely from those society currently expects, demands, and rewards. It will require decades for society and the medical profession to develop, adapt, and implement these fundamental changes, but we must begin NOW. The basis for any successful “New Health System for the 21st Century” must be patient-led.