Technological advances in recent decades have had a significant influence on medicine today, with successful results in the diagnosis and treatment of diseases. But the price of this technification carries the risk of dehumanizing medicine by being more concerned with curing diseases than with caring for people who are sick.
In 1904, William Osler, a Canadian physician considered one of the fathers of modern medicine, wrote “it is much more important to know what kind of patient has a disease than what kind of disease a patient has”. Today, a century later, this paradigm shift in the doctor-patient relationship is being consolidated, overcoming the paternalistic protective role of the physician and listening to the patient’s priorities, reflected in the so-called Patient-Centered Care (PCA).
The patient must be the center of attention
The patient becomes the “center” of care, based on the premise that each individual experiences and copes with health problems in his or her own way within the particular circumstances of his or her life. Thus, the approach involves the recognition of each person as a unique being with a life history or biography that justifies his or her priorities, values and/or religious beliefs.
ACP seeks to provide care that is respectful and responsive to the patient’s preferences, needs and values, and to ensure that the patient’s values guide all clinical decisions with the aim of prioritizing his or her dignity and improving his or her quality of life. The patient then decides on his preferences in the field of health, but for this he needs information to help him in the elaboration of this final decision, by the specialist in Geriatrics.
Importance of advice from the geriatric specialist
Indeed, the new change in the doctor-patient relationship involves empowering patients and their families to take an active role in making important decisions for their health, and this requires listening to them, informing them and involving them in their care. The physician should offer the different therapeutic options, describing their risks and benefits, allowing the patient to express his or her preferences and values. Examples include decisions about major surgery, medications to be taken and/or complementary tests.
The ACP model is having an important development as an element of care improvement in the field of geriatric residential care and dementia. The main contribution lies in this “active” role of the elderly in decision-making, even when they are cognitively impaired, in order to safeguard their dignity and subjective well-being. In Spain, slowly but progressively, more and more geriatric centers are incorporating this model of care for the elderly, trying to adapt a personal and individualized care in the daily activities that can be performed in the residence and/or social-health center.
ACP consolidates respect for the autonomous decision of all people, regardless of their age and/or disability, and prevents excessive care from supplanting and preemptively appropriating the will of the patient, especially in the field of geriatrics.
“My life, my choice, my way.” Three words that guarantee an ACP. Three different words for each person.