Patient-centred care as a way of being
One of the central tenets of family medicine is patient-centred care. At its heart, it asks us to orient towards the person, not just the pathology. We strive to tune into the patient's experience of their illness, their ideas, concerns, and expectations. Alongside this, family and community-oriented primary care (COPC) ground us in context: who this person is in relation to their family, their home, the environment, their work or income (or lack thereof). COPC invites a systemic view: health professionals and communities working together to understand and respond to the needs of a defined population.
As a medical student most of my training focused on the disease rather than on the unique human being experiencing the illness. For the first decade of my career, working in under-resourced rural settings, this remained my orientation: diagnose, treat, “and then the next patient”. When I started working in a rural district hospital under the mentorship of a doctor who had served the same community for two decades, I experienced a model of health care that was truly community oriented. It was especially when I was doing outreach to peripheral clinics, that I began noticing how essential context was — the ways in which a patient’s family structure, culture, and environment shaped their relationship with illness and with care.
However, it was only when I enrolled in a postgraduate degree in family medicine that I really started to grasp patient-centred care. The emphasis on the doctor-patient relationship resonated deeply. It put me in touch again with the reasons why I became a doctor. This was the medicine I had quietly longed to practise. And yet, the overwhelmed and under-resourced primary health care setting with little continuity between health care provider and patient, challenged the relevance and feasibility of patient-centred care. In that setting, I experienced a continuous tension: the ideal of patient-centred care constantly brushing up against time pressure, patient overload, language barriers, and fatigue.
After fifteen years in the public sector, I relocated to a small isolated rural community in Canada where I worked for two years. I was the primary health care provider for a small patient base, seeing a maximum of 12 to 15 patients a day and could spend more time with patients with continuity of care. Initially the individual assessment of the patient, their ideas, concerns, and expectation, did not come naturally to me. I had to continuously remind myself to tune into the patient's experience of their illness. I had to learn to be alert to cues, to explore meaning in their words and silence.
Back in South Africa, I worked as a private GP in small rural towns alongside commitments to government hospital and clinic work. Again, patient-centred care was challenged. In this context, it was not only the time factor that influenced my ability to be patient-centred, but also language and cultural differences. Although I could conduct a consultation in isiXhosa, it often felt like I was only skimming the surface when it came to understanding the deeper layers of a patient’s story.
Returning to the Western Cape, I was able to converse in my home language with most of my patients. I began teaching medical students and family medicine registrars. I witnessed how students tried to practise patient-centredness during their family medicine rotations but often reverted to disease-focused habits in other disciplines. Was it a tick-box exercise, or were they starting to sense the transformative power of truly seeing another human being in their unique context?
One consultation stands out. A mother of two came for a routine follow-up for epilepsy. On gentle inquiry, she revealed she believed her epilepsy could be cured. A traditional healer had told her that a neighbour had cast a spell on her. Her relatives, fearing misfortune, asked her to leave. She moved in with her partner, who refused to live with her children. Her children now stayed with extended family. Her hope of cure was tethered to a deeper longing — to be reunited with her children. In witnessing this complexity, the students could feel the shift: from treating a seizure disorder to meeting a mother in her grief and longing. That moment became a turning point for some of them.
Family medicine registrars often shared that they weren’t able to practise patient-centred care due to workload. I could relate to their frustration in implementing patient-centred care due to time pressure. Over the years, I’ve come to accept that this tension may never resolve — and perhaps, it's not meant to. Instead, it invites a more nuanced practice:
Recognising that patient-centredness exists on a spectrum. Sometimes, it’s as simple as eye contact, a proper greeting, using the patient’s name. These gestures matter, even in a busy casualty ward.
Understanding that quality and quantity are not opposites, but a polarity to manage. At times, volume takes precedence, other times, presence does. Wisdom lies in discernment.
Finding creative workarounds. One registrar committed to offering just one longer consultation a day. Another rearranged their clinic schedule to allow for more spaciousness. These were small but meaningful acts of reclaiming care.
Valuing continuity. We don’t have to do everything in one visit. When there is trust and return, we can co-create care over time.
Now, in the later stages of my career, I work part-time in a local clinic in the town where I live. I see complex referred patients every 20–30 minutes. Time still runs out. Many arrive with layers of complexity: chronic illnesses, depression, pain, family ruptures. I begin each consultation by asking a little about their life, their living situation, their work. I draw quick genograms in their folders — simple tools that allow me to track continuity and relational context. Sometimes, just these small openings allow deeper stories to surface.
Once again, I find myself between the poles: too little time, too much to hold. And yet, there is also a quiet satisfaction. After years of striving, I feel more able to practise in a way that feels whole. My notes may still be messy. My consultations may run over. But something essential has returned: a sense of being present with another human being in their full, complex aliveness.
Within the constraints of a pressured system, patient-centred care remains an aspiration — not as a fixed goal, but as a practice. A way of being. And in those moments when it lands, something healing unfolds. Not just for the patient, but for the practitioner too.
Written by Dr. Hoffie Conradie
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