Public Health in the Age of Patient Centricity


Guest Commentary by on April 10th, 2015

I took a course recently in Narrative Medicine at Columbia University. It was a powerful weekend of reflection on the role physicians play as healers and witnesses in a patient’s journey. On the last day, a non-physician classmate (most were physicians) mused that use of first names with your doctor would break down an imposing and—she argued—unnecessary “authority” barrier. The room bristled. One female doctor stated plainly, “I’ve been to medical school, I take my responsibility as a physician quite seriously and I want my patient to know that I do.” I concurred.

So what have we learned from “MeasleGate?” It turns out that when a doctor takes an authoritative tone with a parent and explains the benefits and safety of vaccines for the child, for society and for the world at large, the parent is much more likely to vaccinate the child. According to a recent Wall Street Journal article on the subject, language is at the crux: 83% of parents resist vaccines when the doctor uses participatory language like “What do you want to do about shots?” But only 26% resist when they take a presumptive approach, such as “We have shots to do today.” And that is a good thing.

“Participatory medicine” and the healthcare industry emphasis on patient centricity has arisen for many good reasons—and we will be healthier in the long run as we take ownership of our health and that of our families. I can assure you, as a mother of two elementary school boys, the daughter of a woman with MS, and healthcare flack for the past 15 years, I am very “participatory” in my family’s health. But when it comes to public health matters, I firmly believe physicians have a duty to be clear. They should presume their patients will follow their recommendations (backed up by the CDC, NIH and WHO) and they should leave no doubt about what they believe.

In this era of patient centricity and political correctness, MDs may be confused about their role in prophylaxis. Maybe they are striving to empathize with the patient’s perspective. But, their duty to science and society could not be clearer. The Anti-Vaxx movement uses emotion and persuasive language to assert itself—prompting VRPs (vaccine-resistant parents) to respond that they would “rather be safe than sorry” if the debunked fiction that meds cause autism turns out to be true. What VRPs may not know—based on their age and ubiquitous nature of vaccines in their lifetimes—is what a scourge these diseases were to the world—and could be again. “Moms in Africa” have not forgotten, according to Melinda Gates. The personal story of Charlie and the Chocolate Factory author Roald Dahl—who lost his 7-year-old daughter to measles in 1962—belongs in the same conversation.

As with many things in life, it all boils down to the power of language. Doctor friends out there: When I meet you for dinner we’ll go by first names. When I come to your office with my child, you are “Doctor.” Don’t leave room for confusion about your authority on health matters, vested through years of schooling and experience. Trying to be equal partners in health won’t get us where we need to go.

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