June 7, 2012

Patient Centered Care

The delivery of health care has traditionally focused on a paradigm known as ‘disease management’ based on guidelines formulated from medical studies and expert opinions. A new trend has emerged known as patent centered care which is a shift away from the disease centered paradigm of the past. Patient centered care involves clinical decisions that are more respectful of and responsive to individual patient preferences, needs, and values. This is especially true in reproductive health as it relates to those suffering from infertility and recurrent pregnancy loss where shared decision making requires setting goals that the patient desires but at the same time are realistic and achievable. This is the challenge. A case in point involves IVF in women of advanced maternal age (>43 yo) and for those with diminished ovarian reserve who desire IVF yet do not have an acceptable chance (>4%) of having a baby with their own egg. In such a context the patient’s desires may not always be viewed as desirable and are often refused contrary to the desires of the patient. This is not an inappropriate response since providers must balance the cost of unhelpful care, albeit care that may be viewed as patient centered, against that which has a meaningful chance of success. Some providers disregard such concerns and promote therapies of very little clinical benefit under the guise of being ‘more patient centered’, yet fully know that their recommended therapies are unlikely to make a healthy baby. This occurs when women 44 years of age and over are offered IVF or minimal IVF to those with either diminished ovarian reserve needing donor egg or to those without the financial resources for more effective IVF treatments. Such practices are ethically challenging as some patients may be willing to spend their hard earned money headless to the fact that their chances for a baby are next to nil. Doing what is right for the patient and what she desires are usually compatible goals. However, doing what is morally and ethically right for patients should be paramount. All practices should adhere to a common code of ethical conduct and work in collaboration with each of their patients to create an individualized patient centered care plan that will best help achieve a healthy baby.

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Joseph A. Hill, III, M.D.

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility