Patient-centered care has gained a lot of currency in the last two decades. But what does this model of care look like? How involved can (or should) patients be? And what are the implications for medical education?
The answers might surprise you.
The Centre of Excellence on Partnership with Patients and the Public, based out of the University of Montreal, has quickly become a world leader in patient-physician partnerships. In less than a decade, co-directors Dr. Philippe Karazivan and Mr. Vincent Dumez, along with Dr. Antoine Boivin and Dr. Marie-Pascale Pomey, are proving that patient experience and knowledge are essential to the evolution of the health care system and to medical education.
“What’s surprising is that when you start to work with patients I thought that it was going to be more difficult, the solutions would be more complex, we’d have to change more things; but it was exactly the opposite,” said Dr. Karazivan. “You realize the problems you identified are not always the problems that are most important for patients, and the solutions may be simpler.”
New and old ways of thinking about patient engagement
The centre’s expertise is in the methodology of working with patients. Their full-integration approach is different than usual forms of patient engagement and it took a while for their colleagues to adapt.
Dr. Karazivan explained, “People are used to thinking that engaging a patient [in medical education] is inviting a patient into a curriculum or course that’s already fully built.”
In contrast, they work to bring faculty and patients to the same table to co-construct a course or presentation together.
“That’s the key difference,” he said, adding, “One of the main risks we have is tokenism. Showcasing patients but with no intention of learning from them or openness to change. Some people just want patients to say what they want; that’s not what we do.”
The solutions aren’t always difficult
Beyond medical education, involving patients as partners has had significant results in clinical settings. Dr. Karazivan gave this example.
“We were invited to a hospital to help them think about ways to reduce wait times. They wanted to work with patients on a solution. Around the table were doctors, managers and staff. We were coming up with all kinds of really complex solutions. Finally, one of the patients said, ‘Can I just tell you about my experience? Of course we would like to wait less, but waiting is okay. You know what’s not okay? Not knowing how long we’re going to wait. That has all kinds of implications for my work and for my home.’ The hospital realized that this one change could improve the patient experience.”
The origins of the Centre of Excellence
Mr. Dumez has a background in finance and management. He is also a severe hemophiliac. Through his former consulting firm, he met the dean and several vice-deans of the Faculty of Medicine at the University of Montreal.
“They knew me as a consultant, but very quickly they learned to also know me as a patient. We all agreed that because of chronic disease, the democratization of access to information on the net and so on, the behaviour and expectations of patients were changing. This has to impact how we train doctors. We need to prepare them so that they don’t take it as a threat if a patient comes into their office with a self-diagnosis, for example.”
The dean at the time tapped on Mr. Dumez to start the patient partnership program. That was in September 2010. It was the first model of its kind.
As Mr. Dumez described it, it was “like a patient driving a faculty unit.”
Dr. Karazivan, a family physician and medical education researcher, came on board a bit later after meeting Mr. Dumez at a conference.
“To be completely honest, I was quite skeptical at the time,” he explained. “I was not sure about this whole patient-as-partner movement. I wondered about the educational, theoretical, conceptual and epistemological basis of it. But Vincent and I started to talk really honestly about all kinds of issues related to care, education and research — myself as a doctor and him as a patient. It was something quite new for me, even though I’m a physician and I see patients all the time.”
Role models of success
Today, as co-directors of the centre, Mr. Dumez and Dr. Karazivan and their two colleagues lead a team of close to 20. They are in charge of a full curriculum that runs from the first to third year of specialization. It focuses on collaboration, ethics (clinical, research), communication and professionalism. All the contents are co-created with patients and delivered with patients as trainers. They have more than 200 carefully recruited patient-trainers who also collaborate with other inter-professional disciplines.
“It’s not about finding the good patient for the good project; it’s finding the good duo [patient with professor],” said Dr. Karazivan.
Half of the centre’s activities are linked with the University of Montreal and hospitals in Quebec. For the last five to six years, they have been sought out by the Canadian Institutes of Health Research and other linked research networks in Canada. They are also helping interested universities deploy similar models, including overseas in Italy, France, Belgium and Switzerland, and recently in the United States.
Dr. Karazivan and Mr. Dumez were featured speakers at this year’s Fellowship Affairs Summit, which was held June 7-8, 2018, in Gatineau, Que. The Fellowship Affairs Summit is a biannual event that brings together the Royal College’s Fellowship Affairs Committee and its subcommittees (Awards, History and Heritage Advisory, Regional Advisory) to discuss/provide feedback on emerging Royal College programs and policy, and to participate in learning opportunities. The theme this year was “Connecting & reflecting: thinking differently about our learning needs, our patients, our colleagues.”
With a recently-approved strategic plan that places patients at the centre of our work, the Royal College is increasingly seeking out opportunities to learn from and engage with patients.