“Nothing About Me Without Me”: Patient-Centered Care

Submitted by Michael Barrett, MD, Augusta Health Transitional Care

Spring break was in Greece. With 3 physicians in 2 families, it was inevitable we would end up at Epidaurus, birthplace of Asclepius and site of the famous sanctuary dedicated to him. For 1000 years it served as the most famous healing center of the Greek and Roman world. Many consider this sanctuary as the “birthplace of Medicine”. Aesclepius, of course, was a beloved god of healing. The fact it was ruins on our visit did not subtract from the grandeur of the site nor the environs. It was set in the rolling hills of Peloponnesia, a venue that was verdant and singular. The remains spoke of a more magnificent architecture from days gone by. It was a campus of complexity which included the ruins of a restaurant, gymnasium, hospice, dormitory, famous Theater, and a stadium. Other structures, which linked the practical to the spiritual, included the Tholos (altar), sanctuary, and an imposing statue of Asclepius.

Appreciating the present-day shadow of its former self, one could imagine how appealing the sanctuary must have looked in full form to those pilgrims seeking treatment long ago- many traveling weeks or months over long distances hoping for a healing visit from the god himself. This visit would occur in the Abaton during the incubatio– a sleep with the goal of achieving a divine connection with Aesclepius. Hopefully, the god of healing would visit and prescribe the task required to affect a cure. This would then be shared with the priest/physician. Many other rituals, activities and visits with the priests/physician took place. However, the incubatio was the focal point of healing.

The experience had to be appealing to the average Greek seeking relief, and it was this very allure that must have formed the underpinning of the sanctuary’s huge success and longevity. As I was contemplating on the sanctuary, the concept “patient – centered” came to mind- a phrase that we have heard much about over the last 15 years. Though I will not formally argue whether the site fits all the criteria proposed to define this concept, to me it was patient-centered. Reviewing this concept seemed a good way to round out and complete the awesome experience I had at Epidaurus.

“Patient centered” as a guiding principal gained prominence in 2001 when the Institute of Medicine published Crossing the Quality Chasm – A New Health System for the 21st Century.  It revealed the elephant in the room- that medicine had fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately. Proposed were 6 specific aims for improvement, one of which was “Patient- Centered”. Its definition: “providing care that is respectful of and responsive to individual patient preferences, needs, and values, end ensuring that patient values guide all clinical decisions”. It seemed that focus on technology and cure had left the patient behind.

The new paradigm defined patients as unique living beings, and an obligation to care for them on their own terms, in the context of their own worlds. A good outcome must be defined in terms of what is meaningful and valuable to the patient-a shift in focus away from diseases and back to the patient. This required a far deeper interaction with the patient to understand his/her experience and an understanding that for most medical decisions, there exists more than one reasonable option. Two phrases coined with this movement succinctly sum this up: “Nothing about me without me” and “ask not only what the matter is but what matters.”

The sanctuary at Epidaurus exemplified much of this. The experience was deeply personal – the patient interacted closely with the doctor/priest in an inspirational, professional, and religious context. Social station was not prohibitive. Surrounded by the very things the average Greek loved, it was clear the patient was the focal point. The visit in a dream by the revered Aesclepius confirmed this. What better way to engage in your own health care decision than to have a dream, reflecting your deepest thoughts and values, from which you decide what elements to divulge to the priest and what actions to take or not to take in your treatment? Epidaurus truly was about the patient experience, was patient-centered, and exemplified the concept “nothing about me without me.”

Sanctuary of Asclepius at Epidaurus