Patient Centered Pragmatism

Patient-centredness has long been touted as a fundamental goal of modern healthcare – but for just as long there has been contention around what is meant by the term. We believe there is a fundamental respect for patient values, wishes, and beliefs that form the foundation of patient-centredness, but stop short of implying that patient wishes are somehow determinative. Patient-centred pragmatism, recognizes the fundamental responsibilities both clinicians and patients have in the consent process, and in particular that it is physicians who generally propose treatments and treatment plans. The implication is that patients (and their substitute decision-makers where patients are incapable) are only able to consent to treatments that have been proposed. While concerns have been raised that this approach allows a physician’s personal value judgments to interfere with patient self-determination, we believe these are based in a misunderstanding of physicians’ responsibilities to offer all treatments that reasonably fall within the standard of care, or are indicated.