Patient-centredness: meaning and propriety in the Botswana, African and non-Western contexts

Abstract

Patient-centredness is a key principle in Family Medicine. It is covered in a Family Medicine textbook by McWhinney and textbooks edited by Goh et al., Rakel and Rakel3 and Mash and Blitz-Lindeque, to name but a few. Patient-centredness (PC) is an extension of the biopsychosocial approach to patient care which was championed by Engel. The term ‘patient-centredness’ was coined by Balint to emphasise that patients should be treated as unique individuals and was used initially to describe how physicians should interact and communicate with patients. From highlighting and emphasising the patient’s agenda and appropriate communication skills in doctor–patient interactions, PC grew to include optimal patient–healthcare system interactions. This established the meaning of PC which was distilled by McWhinney as ‘seeing the illness through the patient’s eyes’. A method of practising PC was then described as paying attention to ‘patients’ cues and behaviour’ and also referred to need for the physician to provide an environment that is conducive to patients’ full and free expression.8 Others outlined the method as ‘exploring the illness experience, understanding the whole person, finding common ground regarding management, incorporating prevention and health promotion, enhancing the doctor–patient relationship, and being realistic about the doctor’s personal limitations’.9 Variations of this method are described and they have a similar outline.