Ms. Jones left the first appointment with her psychiatrist with a sense of relief, yet with a vague sense of unease. She had finally agreed to see the psychiatrist at the suggestion of her primary care physician, whom she had asked for medical excuses for her multiple absences from work for symptoms of fatigue, lack of energy and motivation, weight loss, sleep difficulties, and crying spells. A medical workup had been “negative, and her primary care physician felt that she needed a thorough evaluation of her likely serious depression. Ms. Jones had liked the psychiatrist. She was kind and took her symptoms seriously. She gave Ms. Jones a prescription for an antidepressant medication, and, for the first time in months, Ms. Jones felt that there was hope that she would finally begin to feel better. However, as Ms. Jones recounted to her best friend, the risks of the medications had been reviewed “like a TV ad that concludes a lovely scenario of happy people frolicking at the beach with a speed-talker that rushes through all of the possible side effects.” She was most concerned about possible sexual side effects of the medication, as her sex life was the only aspect of her life in which she still felt truly “alive” and fulfilled. Yet, she had felt too embarrassed to bring it up. “I felt like I was in high school again, being too nervous to ask for birth control,” she confided to her friend. “My psychiatrist knows what she's doing, but I don't think she understands me and my needs very well. How do I know if the medication I was prescribed is the least likely to have sexual side effects?” Her friend laughed and replied wryly, “Why do you think they invented the Internet, silly?”
In 2001, the Institute of Medicine published a report, Crossing the Quality Chasm: A New Health System for the 21st Century (5). The report delineated a strategy for improving overall health care, which included six aims of high-quality health care: safe, effective, patient-centered, timely, efficient, and equitable. Patient-centered care was defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (pp. 5–6). Patient-centered care requires effective patient-centered communication skills. Patient-centered communication occurs when the provider facilitates the patient's perspective and the psychosocial context of his or her illness, shares information with the patient in a transparent manner, gives the patient control over health care decisions, and elicits the patient's individual preferences for health care delivery options (1, 5, 6). As the case report above illustrates, patient care is not optimal without close attention being paid to the patient's individual needs and values.