Patient-Centered Medicine-Reply

In Reply. —The thoughtful comments expressed by Dr Reyes-Ortiz and Mr Strouse illustrate one of our points—the evolution toward patient-centered medicine is slow and uneven.

Reyes-Ortiz provides examples that he believes suggest the evolutionary process may be particularly slow for older and seriously ill patients. This may be partly attributable to physician factors but also to patient factors. Perhaps older patients, having spent much of their lives with physician-centered medicine, may be more cautious than younger patients in bringing their own preferences into their medical care. If this is the case, both patients and physicians would benefit from reeducation in this regard. In our article, we mention some of the changes in medical education that are helping to train more patient-centered clinicians. We also acknowledge that these changes in medical education are emerging slowly. We agree with Reyes-Ortiz that incorporating strategies for teaching values and psychosocial skills will likely advance