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Nuances of Patient-Centricity

By Mario Moussa PhD MBA

By Jennifer Tomasik MS

Researchers at the University of Pennsylvania are experimenting with an electronic nose that literally smells disease. In the not-too-distant future, it may be able to detect whether a patient has an infection in the lungs or somewhere else. There is no need to be radiated with an X-ray, or to wait anxiously for two days as bacteria sprouts from a biological sample. One simply lies in a hospital bed while the super-sensitive machine monitors the body’s exhalations.

Of Hippocrates

Hippocrates, the founding father of Western medicine, did it differently. He relied on smell, too. But, he used his actual nose. He sniffed and inspected his patients’ stool, as well as their earwax, pus, and phlegm. Then he went further, recording the details of his patients’ diets, the water they drank, the local weather, and even the positioning of their house. He spent a lot of time getting to know the highly personal facts of his patients’ lives. He was an early practitioner of individualized and holistic medicine.

Rise of the Historical Symptoms Review

But, doctors in the Hippocratic tradition have not always had this kind of intimate relationship with their patients. In 17th. and 18th. century Europe, the standards of human dignity imposed limits, especially on physical contact. Health providers were just as likely to scrutinize the story of an illness as its observable symptoms. Dr. John Symcotts, who had a successful practice that encompassed two English villages, captured his patients’ narratives in casebooks that contained vivid descriptions of intense subjective experiences. One patient, Miss Christian Tenum, complained of “a heavy burden or weight continually pressing down upon the top of her head,” a “pulsing of the arteries,” and “images passing before her eyes.” The diagnosis was unclear. Symcotts prescribed a fluid diet and a medicine that helped her expel stones with her urine. The outcome? Miss Tenum was cured.

Subjective Reporting

In Symcotts’ era, physicians treated subjective reporting as a valid source of information. Using an ancestral form of telemedicine, they even based diagnoses on letters. John Morgan, a founder of the University of Pennsylvania’s Medical School in the late 1700s, offered his expert opinion on patients who lived “ a distance from Philadelphia, whenever the history of the case is properly drawn up and transmitted to me for advice.” Why the emphasis on spoken and written first-hand accounts? In the words of one physician, there was a “repugnance” to physical examination that was “natural and proper.”

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Assessment

Bottom line: intimacy can take strikingly different forms. This is especially important to remember in the world of Health 2.0, where you have so many choices for communicating.

In purely human terms, we think the relationship that Hippocrates had with his patients was neither better nor worse than the one Symcotts had with Miss Tenum or that Morgan had with his epistolary advice-seekers. Hippocrates paid meticulous attention to a patient’s circumstances: emotional outlook, diet, bodily secretions, family relationships and friends, climate, dwelling. Symcotts may not have known his patient in all of these ways, but he could hardly have been more committed to understanding Miss Tenum’s story in her own terms.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. In different, but equally valid ways, can Hippocrates, Symcotts, and Morgan be considered patient-centered? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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