Patient-Centered Medicine: Who, What, and How?

We don’t have a clear idea where health comes from. Our efforts to reform health care to make it more patient-centered and more responsive to the challenges of chronic illness have been too superficial. Three lessons for chronic illness care are derived: 1) we cannot assume that death and disease are the most important targets for health care, 2) we must draw on the patient’s perspective to define the nature of the clinical problem and the criteria of success for our clinical interventions, and 3) we must always aim toward increasing the patient’s capacity for self-care. The patient-centered care of chronic disease requires that we recognize the patient as the primary perceiver and producer of health. We must move not only from the passive patient to the informed and activated patient, but to the autonomous patient. Patient agency is both the primary means and primary end of health care.