Patient-centered model of healthcare could improve ethics of medicine

By Sarah Guy, MedWire Reporter

The patient-centered medical home (PCMH) model of healthcare includes principles of medical ethics and professionalism that could reinvigorate the patient‑physician relationship and enhance the ethical practice of medicine, suggest members of the American College of Physicians (ACP).

With core elements including patient relationships with a personal physician, physician-led integrated team medical practice, and enhanced access to care, the team believes the PCMH is a stepping stone to a brighter future for US healthcare.

"The PCMH model of care aligns well with the traditional principles of medical ethics and professionalism, including the duty to promote the good and act in the best interest of the patient, the duty to do no harm to the patient, and respect for patient autonomy," said David Bronson, president of the ACP (Philadelphia, Pennsylvania, USA), in a press statement.

Lois Snyder (ACP, Philadelphia) and team explain in The Journal of General Internal Medicine how the PCMH concept aligns with beneficence, nonmaleficence, respect for autonomy, and justice ‑ the core principles of medical ethics outlined in the ACP's Ethics Manual.

The emphasis on patient-centeredness as a primary goal for healthcare supports the ethical principles of respect for autonomy and beneficence, through an emphasis on care through all stages of life ‑ from acute care to end-of-life care, say the authors.

Patient autonomy is also supported by the PCMH model through involvement of family members and caregivers in decision-making. This includes physicians making every effort to bridge language or literacy barriers, and an obligation to provide unlimited access to patients' personal health information, without insisting on patient engagement as a precondition for access.

The PCMH model encourages access to a personal physician who manages care through an integrated team, thereby allowing "strong and trusted relationships." However, while a primary physician ‑ in consultation with specialists where necessary ‑ could facilitate this most effectively, there are barriers to realizing this goal such as a shortage of primary physicians, say Snyder et al.

This highlights "the importance of reform in both medical education and the reimbursement structure of medical care, in order to increase the number of physicians entering and remaining in primary care practice."

Finally, the PCMH model promotes ongoing systems improvements that could help physicians meet their ethical obligations in the practice environment, say the authors. For example, access to and continuity of care with trusted providers, effective communication with patients and their families/caregivers, adequate time for office visits, and coordination of treatment across all settings.

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