slide discussion

In recent times, there have been great emphasis on the provision of patient’s care which is directly and based on the need of patients. This form of patient’s care requires the direct input of patients especially in the decision-making process. Coulter and Oldham (2016, p. 114) defined person-centered care as the model of care which involves treating the patient as an equal partner in the design of their care plan. The authors argued that the goal is to achieve outcomes that are meaningful to the patient, while respecting their needs and choices. Tomaselli et al (2020) stated that the form of care focuses on putting the interests of the individual receiving care or support at the center of everything that is being done. Person centered care is a proactive approach to care delivery that also takes into consideration the rights of patients, their interests and their point of view in the different aspects of the process of making decisions as regards to their personal care (Svab and Cerovečki, 2024, p. 3). The main goal of the person-centered care model is to make people's preferences, needs and values guide clinical decisions, and providing care that is respectful of and responsive to them (Lateef and Mhlongo, 2022, p. 12). Person centered care is hinged on several guiding principles and they include dignity, compassion, respect and providing personalized care, coordinated care, enablement of patients (supporting people to recognize and develop their own strengths and abilities to enable them to live an independent and fulfilling life), partner in care, informed decision making and respect for the values of people and preferences. Providing person-centered care can be very tricky and, in many situations, dicey and this is based on the fact that respecting the choices and preferences of patients cannot always be done due to certain factors and variables such as the one that will be critically analyzed in this case study. This report is focused on discussing the ethical, legal and professional processes and requirements in providing personal centered care. The first case study will be focused on. The report will provide a detailed overlay between providing person-centered care and the integration of evidence-based practices. Furthermore, the report will also make use of the stipulated legal framework to identify where person-centered care cannot be enforced as it might cause harm to patient even when the evidences have been given to the patient receiving care.

To provide a detailed summary of the case study, Aaron Abraham is asking his GP to prescribe medications for depression even when it is evident that the medications will counteract the medications which are being used to deal with his blood issue. The GP’s denial is based on the evidence that if prescribed, the medications will bring about huge side-effects and dependency but Aaron Abraham is insisting on his rights, the need to respect his decisions and the inability of the GP to impose his views. The case study showed that there were issues in the relationship between the GP and the patients. Based on the analysis that will precede this section, it will be shown that care providers can create a positive partnership with patient based on empathy and compassion and when a refusal of providing prescription is given, the patient will know it is from the place of empathy, compassion, positive patient outcome and future independence of the patient. Wolf et al (2017, p. 2) stated that patients appear to value a process of human connectedness above and beyond formalized aspects of documenting agreed goals and care planning. This means that when patients are sure that health professionals are interested in them getting better and being independent, they trust their care providers to provide information about their care that is aimed at improving their health outcome.

Firstly, person-centered care is guided by several ethical principles and they include Individuality, Rights, Independence, Privacy, Dignity, Respect and Partnership (Skills for care, 2024 , p.5 and Santana et al, 2017, p. 430). These principles focus on treating patients as individual persons, take into consideration their unique rights, focus on making patients independent especially as it relates to own care, take patients’ privacy into consideration at all times and treat patients with respect, dignity and finally, providing care based on partnerships. Grover et al (2022, p. 1683) stated that patients have the right to be heard as relating with their personal treatment and also have the right to refuse or accept treatments provided by a medical practitioner and these choices must be respected at all times and also their preferences. According to MRSA Action UK (2020, p. 1), the Patients’ Bill of Rights’ of 2007 provided several guiding principles on how patients must be treated based on the person centered care delivery of care and some of the most prominent sections include;

i. Patients must always be provided with full and sufficient information to facilitate informed choice as to their healthcare

ii. Patients have a role to speak up and to challenge unsafe practice, and the right to expect any challenge to be acted upon

Mold (2012, p. 233) stated that The Patient Bill’s of right is the foundation for the development of care process that takes into consideration the need of patients and their different rights. The author stated that the Patients’ Rights Bill was intended to “Establish the rights of patients to privacy when receiving hospital treatment under the National Health Service,” and it proclaimed that patients had a “right to receive all forms of hospital treatment without any person being present other than those who are necessarily concerned in the provision of that treatment.

Giusti et al (2020, p. 3) explained that patients’ need which must be taken into consideration must be guided by evidence-based practices and detailed researches and information but at the center of the entire service delivery, patients have the right to accept or reject a service that is being rendered and also ask for their preferences and needs to be taken into consideration.

Mayer et al (2023, p. 7) stated that individuality is the foundation for the provision of person-centered. The authors argued that each person has their own identity, beliefs, values, needs, and choices and these variables must be considered in the provision of healthcare services to patients.

As regards to rights in person centered care, Skills for care (2024, p. 10) stated that The Human Rights Act 1998 is the main legislation that sets out the rights of people in the UK. The report stated that patient have the right to speak their mind and be kept safe from harm, as well as the right to respect, dignity and equality. It is the role of healthcare professionals to make sure an individual’s rights are respected, not only by the care professional but by other people involved in their care. Fridberg et al (2021, p. 13) implied that in the provision of person-centered care delivery, the right of patients must not be ignored especially right to confidentiality, anonymity, equality and others.

Independence is a crucial aspect of the need and impact of person-centered care. According to Lamas et al (2021, p. 730), independence in care means to look at what patients can do for themselves and empowering them to do as much as possible for themselves. Care providers focus on helping patients to be independent as possible with the aim of achieving increasing improvements in their ability to take care of themselves (Giusti et al, 2020, p. 7). For privacy in person centered care, the value involves not sharing the information, medical reports, test results and any other information to a third party without having or taking informed consent from the patient (Kuziemsky et al, 2018, p. 50). Santana et al (2017, p.433) argued that it is unethical to share the information of patients to any other person even in the situation where the patient cannot give consent due to the health condition. Lamas et al (2021) argued that there are some exceptions to the above rule and confidentiality right such as to prevent imminent physical danger to the patient or others and for risk management. Based on the principle of dignity, Roos et al (2023, p. 225) stated that it involves providing care that supports the self-respect of the person, recognising their capacities and ambitions, and does nothing to undermine it. There are certain situations whereby patients are ambitious based on their needs but these needs cannot be adhered to especially when it goes against the evidence-based care practice which is being adopted to provide care (Duff et al, 2020, p. 90). Healthcare providers must be able to inform patients of the limitations and issues associated with the provision of certain care and adherence to some care plans. Respect is very well associated with dignity in person centered care (Kvanstorm et al, 2021, p. 21). Dignity includes respecting what patients are capable of doing at a particular point in time, who they are, and the life they have lived (Lamas et al, 2021). The infusion of respect and dignity seen as a central part of quality in healthcare practice.

Partnership in care is the foundation for other principles associated in providing person-centered care. Wolf et al (2017, p. 5) argued that both formal and informal partnership in care is crucial in provided excellent person-centered care but they based on empirical evidence, patients are known to prefer informal partnership with health professionals. Based on the study carried out by Wolf et al (2017), patients appear to value a process of human connectedness above and beyond formalized aspects of documenting agreed goals and care planning. Coulter and Oldham (2016, p. 115) argued that person centered care increases patients’ confidence in professionals who are competent and able to make them feel safe and secure. The authors further stated that informal elements of partnership provide the conditions for communication and cooperation on which formal relations of partnership can be constructed.

From an ethical point of view, providing person-centered care cannot be effective in reaching positive health outcomes if the practice is not guided by making use of evidence-based practices. Cardoso et al (2021, p. 7) defined the concept of Evidence-based practice (EBP) as a systematic process that uses the best available evidence to make decisions and guide actions. The aim of the medical model is to remove any form of biases which might affect the provision of effective care, improve the process of making decisions and improve work-based partnership (Dagne et al, 2021, p. 6). According to NHS England (2024), the adoption of evidence-based practices and interventions are crucial in providing holistic patient care based on the fact that it is effective in reducing unnecessary interventions and preventing avoidable harm. By taking a critical look at the evidences which have been collected without bias, care practitioners are able to provide reliable information for patients to make decisions that are informed and also help in achieving positive health outcomes (Cardoso et al, 2021, p. 10).

The case study which is under consideration provides a case whereby patient’s needs and preferences can be ignored by a care giver or GP (general practitioner) due to ample evidences that the course of care or action of the GP “will” have negative impact on the patient. Damarell et al (2020, p. 15) stated that providing person-centered care in the situation of comorbidities contributes huge challenges to the ability of care providers to efficiently provide person-centered care. The authors explained that for GPs to provide the patient-centred care and coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address the prevailing issues such as the impact of certain medications on other issues in the life of the patient and in such scenarios and situations, refusal to provide the service which go against the needs of patients become imperative. According to BMA (2018, p. 5) and based on the topic, “prescribing in general practice”, general practitioner (GP) may refuse to prescribe a drug because the person who signs the prescription is legally responsible for the drug and its effects. The prescriber is responsible for ensuring that the medicine is appropriate for the patient, within their competence, and need. According to Edershein and Stern (2009, p. 7), medical health professionals have prescriptive authority even in person-centered care situations. The authors defined prescriptive authority as the ability of healthcare providers to prescribe specific medications, including controlled substances to patients. Tzeng et al (2021, p. 10) also argued that prescriptive authority also involves the ability to refuse to prescribe certain medications based on the supposedly impact of the medications especially when their other issues in the life of the patients. Zhang and Patel (2023, p. 121) stated that prescribing is a complex task that involves making decisions based on a judgment of the potential risks and benefits, while taking into account the patient's specific factors and available evidence.

Picton et al (2016, p. 472) argued that GP has the right to refuse medication based on detailed evidence of the impact of the medication and the presence of comorbidities that can be exacerbated due to the prescription of the medication. Kling (2013, p. 38) provided certain instances where GPs might refuse to provide medication and one of them is “when providing the requested treatment would otherwise violate one’s duties as a physician, such as the Hippocratic mandate to first do no harm “.

Furthermore, the refusal of medication can also be based on the evidences which are available as regards the impact of the medication on the already physical health issues. Cox (2021, p. 198) discussed that evidence-based practices must be enshrined in the prescription of medication by medical practitioners. By taking into consideration the prevailing evidences and the state of health of the patients especially when there are several underlying issues, medical practitioners become equipped to make the best decision as regarding prescribing and also have ample evidences to communicate with patients as regards refusal (professional conduct and communication will be discussed later).

Based on the case study, patient individuality must also be taken into consideration when making decisions as regards to patients need especially as it relates with medication prescription. Cox (2021, p. 199) argued that by looking at the personal information of patient and the peculiarity of their medical needs and situations, informed decisions can be made. Individuality plays a significant role in medication prescription, as the process involves interpreting clinical trial evidence in light of a patient's unique factors (Molist-Brunet, 2022, p. 420). For health care professionals, individuality might include the understanding the patient's health problem, assessing the benefit-to-harm balance and pharmacogenesis (Wang and Perri, 2022, p. 174). Proper individuality helps in the prevention of medication errors, which are a significant cause of patient harm in healthcare settings (Cox, 2021, p. 199). Based on the evidence, it is obvious that refusing depression medication for Aaron Abraham (the patient in the case study) is in-line with the person-centered care principle of individualism and this is because person centered focuses on making use of evidence of the individual state, taking into consideration other variable factors associated with the patient.

As regards to the case study, it should also be noted that the right of patients to get the needed information which informed the refusal of medication prescription must not be eroded. Fridberg et al (2021) stated that it is the job of the medical health professional to state the reasons behind the refusal of medication because it is the right of the patient to know the basis of refusal and other treatment plans or medication that can be used. Cox (2021, p. 196) argued that even though the needs of patients are the basis of the person-centered approach, the needs of patients must be looked and assessed based on the prevailing, the ethical responsibilities of care provider and the need to keep the patient safe/ positive health outcome. Roos et al (2023, p. 230) also argued that even though the dignity of patients is also at the forefront of person-centered care practice, patients must be provided with all the necessary information which is a motivating factor for where a specific care plan is not being followed or why a prescription is being rejected or not issued.

From a personal experience, a treatment plan or prescription might provide temporary relief but at the end of the process, it brings about future issues. Working with Sickle Cell Disease (SCD) patients in Nigeria provided several experiences of the need to follow evidences when providing person-centered care. There were situations where patients continually opioids (strong pain relievers) due to the intense pain they are feeling but they are refused due to the harsh side effect of being an addict which consequently leads to the abuse of drugs. Boyd (2024, p. 64) stated that opioids and analgesic pain management is crucial in the treatment of people with advance pain such as people with SCD. Fusieni et al (2021, p. 1295) argued that treating patient with dignity and respect can be viewed from the place of carefully and professionally providing patients with detailed information why a drug cannot be administered or why a prescription cannot be given at a particular point in time. Healthcare professionals providing person-centered care must be equipped with the technical know-how of how to relate with patients compassionately and with empathy even when refusing to administer or when administering (Jeffery, 2016, p. 450).

Wolf et al (2017, p. 7) argued that providing or rejecting patient’s asking for certain medications can be done better or more effective and this is based on the level of communication, collaboration, partnership, empathy and compassion in the communication process with patients. Gorli and Barrelo (2021, p. 10) stated that informal elements of partnership provide the conditions for communication and cooperation on which formal relations of partnership can be constructed.

· Partnering with patients – Vanstone et al (2023, p. 20) stated that it is the duty of healthcare professionals to create successful partnership with patients as it helps in increasing patients trust on the quality of services that is being provided and helps in increasing the ease at which decisions are made based on patients care. Wolf et al (2017, 8) further stated that informal partnership between health professionals and patient are now readily and are used as a basis to provide quality care for patients. Professionals can also partner with the families and relatives of patient and involve them in the processes of decision regarding patient’s care.

· Explained treatment options and respects patients’ decisions – It is the duty of care professionals to provide detail information (evidence-based information) and treatment plans to patients and give latitude to patients to make decisions regarding their care (Cave et al, 2019, p. 20). In person-centered care, the responsibility of patient care most times falls on the patient and for patients to make informed decision, care professionals must make available and explain the treatment option to patients. Coulter and Oldham (2016, p. 114) implied that patients must be given all the necessary tools and information to make the right decisions and, in all situations, detailed overview of the treatment plans and options must be provided.

· Support patients to learn about their health - Edgman-Levitan and Schoenbaum (2021, p. 4) stated that in person centered care (PCC), healthcare professionals must be able to push patients to be conversant about their health, the different risk factors associated with their health issues, the actions to follow for improvement in healthcare and other information. Boyd (2024, p. 88) argued that healthcare professionals must point patient to where the information can be accessed and teach them about consequences of making poor health decisions and actions. Based on the case study, it is evident that if the GP had provided the necessary information and supported patient to learn about their own health, asking for a medication to treat the depression will not have suffice.

· Help patient to achieve independence and stay independent – This is a continuation from the last key point. Ebrahimi et al (2021, p. 220) wrote that healthcare professionals providing person centered care are tasked with the need to continually help patients to become more independent and stay that way and to achieve this, professionals must show empathy, compassion and sincere concern, help patients eat healthy, encourage exercise, provide evidence-based information that will facilitate improve health outcome and help patients to build resilience. Coulter and Oldham (2016, p. 116) further stated that health care can make use of both formal and informal communication process to help patients stay independent to avoid relapse.

· Communicate and coordinate care - Fusieni et al (2021, p. 1300) stated that it is the professional job of the healthcare professional to communicate and coordinate care. The authors stated that communicating and coordinating care is the process of sharing information and organizing activities to ensure a patient's care is effective and safe. Information sharing must be done with patients to help patients make decisions in an effective manner.

· Tailor care to suit patients' needs – The care plan which have been created must be based on patients’ needs and it is the duty of the professional to tailor the care based on the needs of patients (Coulter and Oldham, 2016, p. 115)

The report is focused on discussing the ethical, legal and professional concepts and requirements in providing personal centered care. The first case study was selected based on the fact that it provides an explanation of the thin line and relationship between person-centered and evidence-based decision making. This report also provides a detailed overlay between providing person -centered care and the integration of evidence-based practices. Furthermore, this report makes use of the stipulated legal framework to identify where person-centered care cannot be enforced due to the fact that it will cause harm to patient even when the evidences have been given to the patient receiving care.

Based on the discussions and the overreaching case study, it was found out that providing person-centered care cannot be effective in reaching positive health outcomes if the practice is not guided by making use of evidence-based practices. Evidence-based practice is a key component of patient-centered care because it helps healthcare professionals deliver the best possible care by combining the latest research with clinical expertise and patient values in order to deliver the best possible patient care. Person-centered care in the situation of comorbidities contributes huge challenges to the ability of care providers to efficiently provide person-centered care. The report explained that for GP’s to provide the patient-centered care and coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address the prevailing issues such as the impact of certain medications on other issues in the life of the patient and in such scenarios and situations, refusal to provide the service which go against the needs of patients become imperative.

The result of the analysis found out that general practitioner (GP) may refuse to prescribe a drug because the person who signs the prescription is legally responsible for the drug and its effects. The prescriber is responsible for ensuring that the medicine is appropriate for the patient, within their competence, and need. Finally, this report stated that providing or rejecting patient’s asking for certain medications can be done better or more effective and this is based on the level of communication, collaboration, partnership, empathy and compassion in the communication process with patients.

1. Harris, C.M. (2018) Prescribing in general practice. CRC Press.