Insights (Essays)

Insights (Essays) October 2013

Art of Caring with the Science of Cure

Lisa Shiozaki and Hugh MacLeod

It is great to be on “the balcony of personal reflection” with patients and family members and be reminded about who we are here to serve. In 1904, William Osler wrote: “It is much more important to know what type of patient has a disease than what sort of disease a patient has.” It was important then for a patient to be treated as an individual, with a unique set of values, seeking care and guidance to manage their health. After more than a hundred years, patients continue to hanker after the same etiquette, guiding principles and involvement from their healthcare system.

Today, the mechanics of cure and diagnosis are much more advanced than they were in 1904, yet patient satisfaction levels and safe outcomes are not consistently being met. The current patient profile in Canada includes individuals who are informed (due to this Internet era); who may have diverse ethnic blending; or who are passive recipients of care (usually the elderly). 

Suddenly the Ghost of Healthcare Consciousness appears and says:

“These are three broad characterizations, but do they demonstrate the ever-changing complexity of patients, necessitating flexibility in the approach of care providers? In the healthcare system today, you deal with patients that may not want particular procedures preformed, such as blood transfusions. Regardless of the exact root, a patient’s religious, cultural or personal beliefs are individualistic rationalizations that must be respected. After all, it is the patient who needs to drive their own health journey. In addition to the support given by expert care providers, patients also rely on their defined families, affiliations and available services.” 

It is important that these choices, and chosen support systems, are met with a common courtesy. Patients, like all people, are greatly influenced by the way they are made to feel. Let us remember that it is the life and wellness of the patients that is at risk and, therefore, it is only natural that they want to be involved in the process. As a patient, they may give up much of their power to the professionals and expertise that surround them, but that does not diminish their need to have an active role in their care management.

The Ghost interrupts once again to say:

“In the present patient-centred care delivery model, providers are putting the patient at the centre of their approach, based on their professional expertise. Unfortunately, there is a lack of alignment as each team member orbits around the patient on their discipline-specific trajectory. This lack of collaboration becomes even more pronounced as patients move between care areas and across the phases of care.”

It is true, there is a lack of collaboration, especially where patients move from department to department, clinic to hospital and all other multi-clinic encounters. We need to address the needs of the Canadian healthcare consumer and adapt the current system. Our goal should be to provide a care experience that will further patient empowerment, demonstrate compassion and redefine the quality of the clinical encounter.

Patient satisfaction levels will be enhanced by bridging the gap between patient needs and provider approach. The approach to care becomes more specialized to each patient, providing tailored education, active listening to the patient’s ongoing issues, timely follow-up and caring service. By knowing the patient better, safer outcomes can be achieved.

A patient-driven system will put the patient in the driver’s seat with the power and tools to define their health journey. The patient’s family is in the passenger seat (riding shotgun, if you will), supporting the best choice at the care junctures. The care providers become the back-seat drivers, offering suggestions and expert advice while facilitating patient choice through caring interactions.

To implant the following characteristics, it is important that the delivery approach transitions from the patient group’s generic needs to a care management model that is sensitive to the individual. It is equally important that the patient and their defined family are participative partners in their provider-guided care. The provider’s role must be expanded from caregiver to facilitator and system navigator. This transition allows the caregiver to focus on the informed choices of the patients within established standard of care parameters. Lastly, we must be cognizant of the expectations of the patient and family, cultural diversity and individual life goals.

This model of care delivery could enable the healthcare system to deal with changing patient demands by placing more responsibility and capacity for wellness with the individual. Primary care management would become the cornerstone in the sustainability of the system. Improved partnerships and linkages with the community, patients and their families, together with clearly articulated accountabilities, will prepare the healthcare sector to proactively manage health needs.

Three recommendations for your consideration:

  1. Clinical autonomy is defined and is consistent with a systems view of quality and accountability. 
  2. Clinicians understand their obligations and commitments to the organization and to the people they are there to serve. They participate in organizational improvement as fully integrated members of the team.
  3. Professionals perceive themselves to be part of teams; they embrace a competency-based rather than a credential-based division of labour and they subordinate their own interests to those of their patients.

We close with a comment posted by R. Robson on the essay “The Patient Voice A Value Game Changer”:

“Far too often I hear the comment that ‘patient stories are just anecdotes.’ They are, in fact, when approached with valid qualitative methods, a reliable source of data and evidence. As we are gradually making spaces at the table for patients and families we must also address our traditional reliance on numbers as the only source of reliable evidence. The ‘stories’ from patients, families, and healthcare providers are an equally important and reliable source of evidence to guide our work.”

Where the rubber usually hits the road is a front line care provider interface with the voice of nursing. Join the conversation posted today: Three Care Provider Voices -  Art of Caring With the Science of Cure, Where Has the Voice of Nursing Leadership Gone, Unravelling and Reconfiguring 100 Years of Tradition


Click here
 to see the First Series of Ghost Busting essays.

Click here to see essays from the Second Series: The Ghost of Healthcare Consciousness.

About the Author(s)

Lisa Shiozaki, Executive Vice President and Chief Nursing Executive at Lakeridge Health with a passion to weave caring into every human encounter.
Hugh MacLeod, CEO, Canadian Patient Safety Institute … Patient, Father, Husband, Brother, Grandfather … Concerned Citizen.


The Canadian Patient Safety Institute (CPSI exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety. We envision safe healthcare for all Canadians and are driven to inspire extraordinary improvement in patient safety and quality. To help address many of the challenges mentioned in the essay above the Canadian Patient Safety Institute has tools and resources such as: Patient Safety Incident Analysis and Canadian Disclosure Guidelines. If you would like information about Patients for Patient Safety Canada – please contact  


Osler, W. 1904. Aequanimitas. Philadelphia: Blakistan.

Robson, R. 2013. Web site posting on essay: “The Patient Voice A Value Game Changer" - Longwoods Ghost Busting Essays.


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