Considering shared power and responsibility: Diabetic patients’ experience with the PCMH care model

The patient-centered medical home (PCMH), an innovative primary care model that fosters a stronger, more personal patient-doctor relationship than traditional health care models, should be particularly well suited for the treatment of chronic conditions such as diabetes that require ongoing management by both patients and providers. Despite growing research on the effectiveness of PCMHs in diabetes care, relatively little attention has been given to diabetic patients’ experiences. This qualitative study examines diabetic patients’ experiences at one PCMH setting, using in-depth interviews to understand patients’ perspectives of the shared power and responsibility between patient and provider in their diabetes care. Our results suggest that even when patients feel comfortable and cared for by the physician, they may choose to take a more passive role in discussions about their diabetes in the clinical encounter because 1) they may see diabetes as a secondary concern, or 2) they may be consciously differentiating between their physician’s responsibility over the physical domain of the illness and the patient’s responsibility over the lifestyle domain of the illness. Thus, in order to build a relationship that is characterized by shared power and responsibility between patient and provider, physicians should not only strive to create an atmosphere in which the patient feels both cared for and listened to, they also need to be aware of patient’s preconceptions about the clinical encounter. This awareness would allow physicians to encourage more active patient participation in the clinical encounter and support patients more effectively in their self-management journey