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Editorial

What do we mean by patient-centred care? This isn't a trick question to find out whether you've been listening in the four years since the Department of Health first made it a legal requirement. Rather it's an attempt to reach a consensual answer.

A common response is that it's about placing the patient at the centre of the care process - making healthcare akin to a tailor made suit, rather than using a 'one size fits all' approach. This is accurate, but what does it mean in practice?

Does it imply patient-centred care is about the public's participation in the planning and redesign of services or the reshaping of policy? Or is it focussed on the need for health professionals to inform patients about their healthcare and give them a choice? Or perhaps patient-centred care is about the partnership between practitioner and layperson: with this relationship rooted in sharing power, rather than upholding a paternalistic attitude.

The concept encompasses all of the above - from the organisational, redesigning services end of the patient-centred care spectrum through to the individual interactions side. However, as a report by Gillespie et al highlights, health professionals, educationalists, managers and patient representatives are all developing different meanings that reflect their own history and position1. These authors believe this variety of response reflects a lack of clarity and leadership from policy-makers. They call for further clarification from the new Commission for Patient and Public Involvement so that a more complete understanding of patient-centred care can be gained.

In addition, there is a danger that a diversity of views will lead to important aspects of patient-centred care being neglected. This research suggests there is an emphasis from policy-makers on the organisational end of the spectrum. They ask whether the individual aspects of such care are seen as being a matter for clinicians rather than managers.

A question the profession needs to answer is what does patient-centred care mean in a physiotherapeutic context? Fortunately, physios are beginning to address this, as we highlight (see page 8). More research and discussion is needed.

Without a consensus about patient-centred care, it is hard to see how further developments can be made in this direction. How can physios and other healthcare professionals in the NHS know if they are meeting the standards of providing patient-centred care? The challenge now is to get talking and find some answers.

1 Gillespie R, Florin D and Gillam S [2004]. 'How is patient-centred care understood by the clinical, managerial and lay stakeholders responsible for promoting this agenda?', Health Expectations, 7, 142-148

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