Updated 25/05/2026
- The Gap Between Policy and Practice
- The Hidden Curriculum: How Doctors Really Learn Patient Care
- Communication and Empathy: Safety-Critical Competencies, Not Soft Skills
- Professionalism as a System-Level Responsibility
- Implications for Georgian Healthcare
- Frequently asked questions
- Why does patient-centred care remain incompletely realised despite international endorsement?
- What is the “hidden curriculum” in medical education?
- How are communication and empathy safety-critical competencies?
- What changes are needed to embed patient-centred care in healthcare systems?
- Looking Forward: From Policy to Practice
Why Patient-Centred Care Fails in Practice: Georgian Study Reveals the Hidden Barriers
Despite decades of endorsement in international policy frameworks and accreditation standards, patient-centred care remains incompletely realised in daily clinical practice across healthcare systems. A new commentary published in the Georgian Medical Journal by Irine Pkhakadze, Tamar Talakvadze and Giorgi Pkhakadze argues that the problem is not clinical competence or technology—it is systemic deficiencies in professional culture, medical education and organisational accountability that prevent meaningful patient engagement.
The research examines why this gap persists and what healthcare systems—including Georgia’s—must do to embed patient-centred care as a collective institutional responsibility rather than an individual clinician trait.
| Barrier Category | Impact on Care | Key Mechanism |
|---|---|---|
| Professional Culture | Reduced patient engagement | Leadership behaviour shapes clinician attitudes |
| Medical Education | Poor empathy and communication skills | Hidden curriculum outweighs formal instruction |
| Organisational Constraints | Inability to deliver patient-centred practice | Staffing pressures, weak feedback, inconsistent role models |
The Gap Between Policy and Practice
Patient-centred care is endorsed globally as a fundamental dimension of healthcare quality. The World Health Organization and the Institute of Medicine have long advocated for healthcare systems built around patient needs and preferences. Yet in practice, clinicians struggle to deliver on this promise consistently.
The Georgian Medical Journal commentary by Pkhakadze, Talakvadze and Pkhakadze examines why this persistent gap exists. “The challenge lies less in clinical competence or technological capacity,” the authors write, “and more in deficiencies within professional culture, medical education and organisational accountability.”
This is particularly relevant for Georgia, where healthcare reform initiatives are increasingly emphasising quality and patient safety. Understanding these structural barriers is essential for embedding genuine patient-centred practice into the healthcare system.
The Hidden Curriculum: How Doctors Really Learn Patient Care
Medical schools teach communication and empathy through formal curricula—yet the Pkhakadze et al. study notes that informal learning and observed behaviour often outweigh classroom instruction in shaping professional attitudes.
The authors call this the “hidden curriculum.” When medical students observe senior clinicians rushing through consultations, dismissing patient concerns or failing to involve patients in decisions, they learn that patient engagement is optional, not essential. When they see role models who listen and explain, they internalise those values.
This finding aligns with international research on professional identity formation in healthcare. The commentary argues that medical education reforms must address not just formal teaching but the entire learning environment—including how senior clinicians model professionalism and how junior doctors receive feedback on communication skills.
For Georgian medical educators, this underscores the need for consistent faculty development and supervision systems that reinforce patient-centred values throughout clinical training. Read more about quality improvement in Georgian medical education.
Communication and Empathy: Safety-Critical Competencies, Not Soft Skills
A major shift in the authors’ argument is reframing communication and empathy as safety-critical competencies—not ancillary “soft skills” that can be deprioritised when time is short.
The Pkhakadze et al. study presents evidence that deficiencies in communication and empathy are linked to:
- Adverse events and patient safety incidents
- Reduced patient trust and adherence to treatment
- Compromised care quality and patient outcomes
When a clinician fails to listen to a patient’s concerns or does not explain treatment options, the consequences extend beyond patient satisfaction. Misdiagnosis, medication errors and treatment non-compliance are more likely. This frames empathy and communication not as ethical luxuries but as fundamental safety mechanisms.
The commentary draws on international accreditation standards to argue that healthcare organisations must measure and hold clinicians accountable for communication competency in the same way they do for clinical technical skills. Explore more on clinical governance and patient safety in the Georgian Medical Journal.
Professionalism as a System-Level Responsibility
A critical insight from the authors is that professionalism cannot be reduced to individual clinician behaviour. Instead, they argue it must be understood as a “collective, system-level function” shaped by leadership, workload design, learning environments and institutional incentives.
If a healthcare facility is understaffed, clinicians cannot meaningfully engage with patients—no matter how committed they are to patient-centred care. If leadership does not model empathetic practice, junior clinicians will not prioritise it. If feedback mechanisms are weak, clinicians have no way to know whether their communication is improving patient outcomes.
“Patient-centred care can only be consistently achieved when professionalism is embedded as a shared organisational responsibility, supported by continuous faculty development, reflective practice and measurable accountability mechanisms.”
— Pkhakadze, Talakvadze & Pkhakadze, Georgian Medical Journal, 2025
This perspective shifts responsibility from individual clinicians to healthcare leadership and accreditation bodies. It means that healthcare systems must invest in workload planning, governance structures and continuous improvement systems that make patient-centred care feasible and rewarded—not just encouraged in policy documents.
Implications for Georgian Healthcare
The commentary examines the Georgian healthcare context directly, arguing for closer alignment between medical education, clinical governance and accreditation systems. This is timely as Georgia’s healthcare sector undergoes reforms aimed at improving quality and patient outcomes.
The authors’ recommendations include:
- Integration of professionalism into accreditation standards with measurable metrics for patient-centred care
- Faculty development programmes focused on role modelling, mentoring and reflective practice
- Organisational accountability mechanisms that link leadership incentives to patient-centred outcomes
- Workload and resource planning that enables rather than obstructs meaningful patient engagement
Key takeaways
- Patient-centred care remains incompletely realised not because clinicians lack competence, but because organisational systems, professional culture and medical education do not consistently support it according to the Pkhakadze et al. study
- The “hidden curriculum”—informal learning and role modelling—shapes clinicians’ attitudes toward empathy and patient engagement more powerfully than formal instruction
- Communication and empathy must be treated as safety-critical competencies linked to adverse events and care quality, not as optional soft skills
- Professionalism is a collective system-level responsibility that requires leadership commitment, workload design and measurable accountability—not just individual clinician effort
Frequently asked questions
Why does patient-centred care remain incompletely realised despite international endorsement?
The Pkhakadze et al. study argues that the problem is not lack of policy support but systemic deficiencies in professional culture, medical education and organisational accountability. Healthcare systems often lack the workload planning, feedback mechanisms, leadership role modelling and accreditation accountability needed to make patient-centred practice feasible in daily work.
What is the “hidden curriculum” in medical education?
The hidden curriculum refers to informal learning, role modelling and observed behaviours in clinical training. The authors note that what students observe senior clinicians doing—whether they listen to patients, explain treatment options, or rush through consultations—often teaches more powerful lessons than formal classroom instruction in communication and empathy.
How are communication and empathy safety-critical competencies?
The commentary presents evidence that deficiencies in communication and empathy are linked to adverse events, patient safety incidents, reduced adherence to treatment and compromised care quality. When clinicians fail to listen or explain, patients are more likely to be misdiagnosed, experience medication errors or not follow treatment advice. This makes these skills as critical to safety as technical clinical competencies.
What changes are needed to embed patient-centred care in healthcare systems?
The authors recommend closer alignment between medical education, clinical governance and accreditation systems. This includes continuous faculty development focused on role modelling, integration of professionalism into accreditation standards with measurable metrics, organisational accountability mechanisms linking leadership to patient-centred outcomes, and workload planning that enables meaningful patient engagement.
Looking Forward: From Policy to Practice
The gap between patient-centred care policy and practice is not new, but this commentary provides a systematic framework for understanding why it persists and what must change. The authors make clear that patient-centred care cannot be achieved through exhortation alone—it requires deliberate restructuring of medical education, clinical governance and organisational incentives to make it possible and rewarded.
For healthcare leaders, educators and clinicians in Georgia and beyond, the message is urgent: professionalism and patient-centred care are not individual responsibilities but collective ones. Healthcare systems must invest in leadership development, faculty mentoring, workload planning and accountability mechanisms that align daily practice with patient-centred values. Only then will the gap between policy and practice close, and patients receive the engaged, respectful care they deserve. The full article is available in the Georgian Medical Journal.
Full citation
Pkhakadze I, Talakvadze T, Pkhakadze G. Commentary Patient-centred Care and Professionalism in Medical Facilities Implications for Medical Education, Communication and Empathy: Why Patient-centred Care Remains Incompletely Realised. Georgian Medical Journal. 2025. doi: 10.5281/zenodo.18109374
Source: Read the full article in the Georgian Medical Journal
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Disclaimer. This article is health journalism intended for general information and education. It is not medical advice and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your individual circumstances. Full disclaimer →
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
