Person-centered care in intensive care medicine

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Mark R Tonelli


SourceURL:file://localhost/Users/mark/Desktop/PCMinICU.anon.docThe provision of intensive care medicine presents particular challenges for a person-centered medicine. The intensive care unit can be a dehumanizing place, where patients often fail to appear to be persons and where burnout and depersonalization on the part of providers is common. Most people who require intensive care are unable to participate directly in their own healthcare decision making. Incorporating individual patient goals and values into decision making, then, requires explicit and active effort on the part of intensivists to elicit that information from a variety of sources. In addition, clinical decision making in the ICU is highly dependent upon pathophysiologic reasoning and technical knowledge that is not readily accessible to individual patients and families. Access to and continuation of intensive care medicine is generally controlled by providers of the service. This locus of control, along with the fact that need for ICU level care generally occurs due to acute, severe illness, means that individuals may be denied or subjected to intensive care against their will. The provision of person-centered intensive care, then, places a high degree of responsibility upon clinicians to ensure that care is individualized and to respect patients as persons. Several practical recommendations to aid clinicians in achieving these goals are offered.

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