But how are we to get there? And does it make a difference?
In a recent article in the Annals of Internal Medicine, Saul Weiner and caolleagues, from Duke and the University of Illinois at Chicago, defined this necessity, calling it "context-dependent care." In their study, patients surreptitiously recorded physicians, and the resultant recordings were analyzed to identify whether doctors appropriately modified their care based on contextual clues provided by the patient. For example, a patient with presumed hypothyroidism might also have depression; a patient who needs insulin may be unemployed and homeless, needing some creative solutions to getting them their medication.
The result of their study? Such modification of care plans according to context actually improved care outcomes. This is an interesting finding, but I think the bigger-picture advance is to recognize what patient-centered care actually is: not a mere elicitation and application of "preferences" (Ms. Gomez, do you prefer X or Y?), but a translation of the care plan into the patient's world, with all the complications and nuance that entails.