Patient centred, principle centred or both?

Sometimes, when things seem too good to be true, it’s because they are.

Imagine a perfect couple. He is a famed actor, noted for his good looks and adored throughout the world, women want him and men want to be him.

One lucky lady did get him, she is equally gorgeous and talented.

Only it turns out they are both bat s**t crazy, fuelled largely by drugs, booze and hate. They have blazing rows, leading to violence and language that would make your milk curdle. Most impressively, she gets so drunk and high, she s**ts the bed and blames the dog ( I guess that tiny Yorkie really can lay some serious cable….)

Amber Heard

I am, of course, talking about the charming Johnny Depp and Amber Heard.

Johnny Depp and Amber Heard

Frankly, they are as bad as each other.

They are both all about one person and one person only….themselves.

As practitioners, we should be interested in one person, the patient.

They have put their health in your hands (literally) and are paying you money to care for them.

The term “patient centered care” is common place these days, you can view any NICE guidance and that is trotted out at the start of all guidance.

Ironically, they proceed to then all too often apply a statistics based evidence drug approach that is then applied via a flow chart by GP’s as they wish.

In short, in my opinion often it is NHS/GP centered or maybe more realistically, pharmaceutical industry centered.

Within some groups, the alternative to being patient centered is being “principle centered”.

This effectively means they are focussed on the principles that underpin the style in which they practice, their philosophy and beliefs.

This can also mean they are focussed to some extent on what the practitioner wants rather than the patient.

This has sadly been part of a schism within the Chiropractic profession for many years.

The tragedy is they are not mutually exclusive, they are both correct, when used appropriately.

In fact, I would argue you cannot have one without the other.

Does being patient centered mean you do what the patient wants?

Bend to their whim and provide services or a schedule of care that you do not wish to

Clearly not!

Often, this may not be in the patients’ best interests for us to comply.

I will not allow patients to attend at a frequency that is less than I believe will allow care to work. Equally, it is not one size fits all.

My waiting time for a new patient is around 4-6 weeks and when they book they are obliged to prebook at least 5 follow-ups.


Because I cannot get them in for follow-up appointments for weeks on end unless they prebook their care. They will not get better if there are 2-3 week gaps between appointments when they are early in care. So the pre-booking is in their best interest (and mine, as I will not work my lunch or stay late to accommodate patients that are not willing to follow our instructions).

So, by being patient centered, I am also following my own principles on what I believe works for patients and also what is good for my own health (I need time to digest!).

So, yes, I am patient centered and my Chiropractic principles guide the care of patients very strongly.

Principles are a framework which we work with and “hang” new knowledge and clinical experience on. But the framework is flexible enough to bend to different patients, to a degree.

You cannot be all things to all people.

Some patients are just not a good fit for some practitioners’ care, but the nuance is it’s not one size fits all, it is a spectrum.

The reality is, we all have principles that guide us, how can you practice without them?

But we must have some flexibility to allow us to work with patients that may have different needs and wants or ability to comply with some of our suggestions.

So, in my opinion, everyone is principled, we have a framework of beliefs around the care we deliver.