My daughter broke her arm recently. A sign on the clinic wall said that she would receive ‘patient-centered care.’

I wasn’t sure who (or what) else it could have centered on (and I had a bit of time to kill) so I googled ‘patient-centered care’ to see what the alternatives were.

Harvard Medical School and the Picker Institute highlight eight principles of patient-centered care:

  1. Respect for patients’ values, preferences and expressed needs
  2. Coordination and integration of care
  3. Information and education
  4. Physical comfort
  5. Emotional support and alleviation of fear and anxiety
  6. Involvement of family and friends
  7. Continuity and transition
  8. Access to care

I’m not going to go into all of these eight principles in relation to Milly’s care. Suffice to say, she received and continues to receive excellent patient-centered care. But I will touch upon the first principle. I think a clinician’s interpretation of this principle is what distinguishes patient-centered care from ‘patient-directed care.’

Milly’s preferences and expressed needs were taken into account but they rightfully did not usurp the expertise of the doctor. Milly did not want an x-ray but she needed one. Needless to say, Milly had an x-ray. But the doctor and radiographer took into account what Milly was telling them and arranged her arm to alleviate some pain in getting the information that they needed. The doctor listened to Milly to understand her situation but he did not deviate from a course of action that his expertise and experience told him would result in the best outcome for Milly.

A child’s broken arm is a bit of an extreme example so here is another one. A patient with a viral upper-respiratory infection demands antibiotics. (Apparently) this is not the best course of action but a doctor who is patient-directed might give it to the patient anyway to keep him or her happy.

This distinction between patient-centered care and patient-directed care got me thinking about what I am supposed to be thinking about: student learning.

I am an advocate for student-centered learning. I interpret it to mean a shift of instructional focus from the teacher to the student. Instead of students adapting to the needs of teachers, student-centered teachers adapt to meet the needs of their students. However (thanks to the patient-centered / patient-directed distinction), I am wary of student-directed learning. Like doctors in medical matters, in matters of learning teachers are trained to diagnose and meet the needs of students. And like patients in medical matters, students cannot be expected to consistently and accurately identify their needs or meet them.*

There is a time and place for students studying whatever they want, however they want. But we must be clear that this is not necessarily student-centered learning. It is student-directed learning. Student-directed learning only becomes student-centered if it centers on the knowledge, skills and/or character traits that a student needs.

It is a teacher’s responsibility to identify a student’s needs and to adapt learning experiences to meet them. Adapting learning experiences to meet the needs of all students is akin to the challenge a doctor faces in meeting the needs of all patients. This challenge can only be met with deep and up-to-date understandings of each student, future opportunities and challenges facing today’s students, and how students learn. Teachers must also be supported within a very clear curriculum structure that allows for teachers to apply that professional understanding with the degree of autonomy afforded to doctors, lawyers, and other professionals to innovate in the interests of those that they serve.

*although I think that this can be taught through student-centered learning that aims to develop student agency.

BROWN, PETER C. MAKE IT STICK: the Science of Successful Learning. BELKNAP HARVARD, 2018.

Milly's Arm