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Patient-centered medicine: the next phase in health care.

What matters most to patients are outcomes: Did I recover? Is my quality of life better? Patients want to know what has been accomplished by the tests and treatments they have undergone and what has been achieved by the time and resources that have been expended. It is time for us to fully embrace patient-centered medicine, which is ultimately outcomes oriented, with a focus on what patients experience and, among the range of medically reasonable options, gives precedence to what patients prefer.

The practice of medicine has evolved from supposition-based to science- and evidence-based, often extrapolating laboratory science to the bedside. However, studies that include patient outcomes are showing, with discomforting frequency, that strategies once considered optimal often fall short of their promise when success is defined as an improvement in what the patient experiences.1–4

Intermediate end points are not a primary concern for patients. Surrogate end points matter only to the extent that they convey information to the patient about the effects of an intervention.5 Unfortunately, surrogate end points have limitations in their ability to convey this information.6 There are gaps between expectations fostered by basic science and what happens to patients. Knowledge of human physiology and pathophysiology does not always reveal which strategies will improve the likelihood that a particular patient will achieve better outcomes.

Changes in risk factors do not always change patient risk in predictable ways. For example, rosiglitazone, which effectively reduced blood sugar levels in patients with …