WHEN we look at the stars at night, we can feel insignificant and small, overwhelmed by the large number of celestial bodies around us. If we take the time to keep searching, we will notice that the stars and planets do not stay in the same position but move through the night sky. Over a longer period of time, we would discover that these astronomical objects appear to revolve around us.
Claudius Ptolemy, who lived between about 100 and 170 AD, also discovered the same phenomenon. A polymath, he was a mathematician, astronomer, and music theorist, who, based on early astronomical observations, wrote a book entitled Planetary Hypotheses, in which he postulated that the Sun and the planets revolved around the Earth. . This astronomical theory, known as geocentrism, became the accepted model for our understanding of the universe for the next 1500 years.
And it is not surprising that it was the predominant and widely accepted theory at the time. From where we stand as human beings, we can observe two obvious things that support this geocentric model.
First, we can see that the Sun and the stars seem to revolve around the Earth in a coherent way.
Second, the Earth itself seems stationary and motionless: it seems that we do not move when we are standing. From our own physical perceptions, it is not difficult, and even reasonable, to conclude that it is the Sun, the Moon, and the stars that move, not the Earth.
Now, obviously, we now know that this model is, in fact, incorrect, thanks to Nicolaus Copernicus, a Renaissance mathematician, astronomer, and physician who, a millennium and a half after Ptolemy, put forward an opposing theory based on his own scientist. observations, which he first published in Commentariolus (or Small Commentary) in 1514, before publishing his magnus opum Dē revolutionibus orbium coelestium (or On the Revolutions of the Celestial Spheres) in 1543. In his work, he outlined the his heliocentric theory of astronomy. which postulated that the Earth and the planets revolved around the Sun, which was contrary to the prevailing scientific and religious beliefs at the time.
Less than a century later, we have Galileo di Vincenzo Bonaiuti of ‘Galilei of Italy, also a mathematician and astronomer, who was almost a doctor (apparently he started medical school first because he thought it was more lucrative before changing course to pursue his career). the true passion for mathematics after only one year in medical school). Galileo wrote Sidereus nuncius (or star messenger) in 1610, in which he supported Copernican heliocentrism, although he was eventually investigated by the church for heresy in 1615.
Similarly, Johannes Kepler was a contemporary German of Galileo, like the others mentioned, mathematician and astronomer, as well as philosopher and music writer. He also supported Copernicus’ heliocentric model when he published a series of books that culminated in the Epitome astronomiae Copernicanae (or Epitome of Copernican Astronomy) in 1621.
One of the reasons Copernicus, Galileo, and Kepler rejected geocentrism was the use of telescopes and careful measurements of the movements of celestial bodies. In a geocentric model of the universe where the Earth is at the center, the orbits of the Sun and the planets do not draw a smooth circle or oval around the Earth if you look at their paths through the sky, but follow patterns that s ‘look like petals. a flower, paths that make many smaller circular orbits around it many times as they orbit the Earth. In fact, the first astronomical graphs based on geocentric models showed chaotic orbits of the Sun and individual planets around the Earth.
Only when you change the model to a heliocentric one and put the Sun in the center does everything else fall into a neat place. The orbits of the Earth and other planets around the Sun follow smooth circular or oval paths, and what we can see and measure begins to make sense.
So why did I share a brief history of astronomy with you? What does astronomy have to do with patient-centered care?
When I was in internship, I remembered how structured and orderly it felt to work in an emergency department (SU), even though the environment itself might be busy. In an ED, I came across my position as a young doctor. I had a resident, a registrar, and a consultant, my medical team. I had a sorting process; He knew when to see a patient, examine him, and ask for evidence. I knew when to climb, when to refer, and when to sign up. For me, patients came and went in a predictable way, and I did my job.
Many years later, my daughter, who was a little girl at the time, felt very unwell with uncontrolled asthma and I had to take her to the local emergency department. I had to wait a long time before I was seen. I had contact with different health professionals: nurses, doctors (both junior and senior, and different in different shifts), pharmacists and radiographers. My daughter and I were taken from the emergency room to the radiologist, back to the emergency room, then to the short stay room and then to the pediatric ward.
They gave me minimal information, and the different teams didn’t seem to know what the other teams were doing, or so it seemed like they didn’t even care, as long as they got what they needed. It was chaotic, like the orbits of stars and suns and planets spinning in unpredictable ways around me, each busy with their own thoughts and work.
That’s when I had an epiphany, one that is obvious and experienced by countless other patients and family members who have come before me, and many more who have done so and will come after.
While we say that the healthcare system is patient-centered, it really isn’t. We designed the healthcare system to be provider-centric. Healthcare workers have designed processes and workflows to be useful to them. For good reason: we want the health care system to be efficient and fit. We need to reduce costs, eliminate waste and be profitable. For doctors, the health care system should revolve around them; in fact, for a long time, it has done so.
This means that when patients enter the health care system, what they experience is a separate and distinct contact with different providers and healthcare teams that seem, and say they do, revolve around patients, but in an unpredictable way. , chaotic and “messy”. orbits. Patients in need of health care should talk to different people and organizations to arrange various appointments for hours that fit the different care teams in a system that is clearly not designed for them, but designed for many years and iterations for different components of the complex world. that make up our healthcare system.
All this despite the fact that patient-centered care is now part of the language of all public and private hospitals, and now each project is mandated to be designed in conjunction with consumers. We are still living with a “provider-centered” health model rather than based on true “patient centrism.” Doctors are still the center of gravity because we still have the place of control.
That needs to change.
To be truly patient-centered, we must take the radical step of dismantling the structures that already exist in the different care teams to make each of the parts separately more efficient, and really design from scratch a single system that puts the patient in the center. This is so that, from the patient’s point of view, they are the ones who are really stable and immobile, and can live with the health teams around them in a predictable and orderly way.
It is a model of the universe in which the patient has the control and ability to get the right care and the right information from the right provider at the right time; a peaceful and structured universe for the patient, even if this is at the expense of more chaos, inefficiencies and costs for providers (although this may not be the case). This model of the universe is “patient centrism.” This model of health care may be virtually unattainable in our current decentralized, fragmented, and isolated health care system, according to some people, and may even be considered heretical by others.
But I know that astronomy coexisted with the wrong model of the universe for 1500 years before a few came up with a new theory. I would rather suggest a new theory of healthcare today that may become the prevailing model, hopefully in a shorter period than this.
Professor Erwin Loh is the group’s medical officer and general manager of the clinical governance group at St Vincent’s Health Australia.
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