Health Care Team (HCT)
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Patients
The U.S. health care system is a patient-centered system. Likewise, the Health Care Team is patient-centered. Patients are not only at the center of health care, they are, in fact, vital members of the health care team.
Patients can be a valuable source of information on their own medical history, essential information for all team members. Though there can be great variability in the accuracy of individual patients’ histories, a well-posed question may elicit critical information. In addition to information about symptoms, the patient also communicates important information regarding concerns, fears, and other factors that may greatly affect his or her participation in medical treatment.
Physicians and other members of the team must always remember that each patient, assuming he or she is competent to do so, makes the final decision about his or her own medical care and treatment options. In order to participate in the decision-making process, patients need to be given the clearest and most complete information possible. To assist patients in their decisions, it is necessary for team members to explain what they are doing and why, offer alternatives when available, respond clearly to patient questions, and have the patience to let patients process information, giving them the time they need to make critical decisions.
Once a decision has been made and a treatment plan initiated, the patient still has a crucial role on the team. While there are many objective ways of monitoring response to treatment, a patient’s report of his or her own experience must always be considered when evaluating outcomes. Hence, there is a need for ongoing, regular, and clear communication between the patient and the other members of the health care team.
It may be difficult for team members, especially physicians, when patient preferences are not consistent with the physician’s decision for the best evidence-based course of treatment. In these situations, it is important to explore cultural, religious, and other factors that may be influencing the patient’s decision. Other members of the health care team, including nurses, social workers, chaplains, and family members, may be of great help in understanding the patient’s concerns and ensuring that these concerns are addressed.
An exception to the patient being in control of his or her medical care is a patient who has been determined to be mentally incompetent. Such patients present unique challenges. While they may not be able to make major decisions regarding their treatment and care, lack of competency should never be used as an excuse to ignore their contribution to the care process. To the degree that they are able, all patients should continue to be heard with respect to important issues such as their comfort and convenience. They should be encouraged to engage in even minor decision making. These principles apply equally to minor children. While they may not be able to make decisions regarding the best course of treatment, they certainly can provide valuable input and should have their requests and preferences addressed and, as far as possible, accommodated.
