Patient-centered care is a key factor to ensure quality in the healthcare system. The USA has been struggling for a long time with its (in)ability to translate the scientific knowledge into practice and to apply the abundant technology safely and appropriately. While main issues discussed now by the USA refer to the shortage of primary care providers and needed reform that ensures appropriate reward for this practice, certainly the Brazilian Unified Health System have some experience to share, after 20 years focusing on the primary care as the chief of its healthcare system. The objective of this concept paper is to critically analyze the issues emerging from the literature related to the patient-centered care in both countries. The Patient Centered Medical Home (PCMH) in the USA and the Family Health Strategy (FHS) in Brazil claim equally to be patient-centered models of practice. However, our analysis revealed different patterns of ‘patient-centeredness’. Most of the discussions around PCMH address issues of payment and organization of the healthcare providers’ team that is heavily influenced by the historical structure of healthcare system; but few address, in sufficient deepness, how to improve the service that is ultimately being delivered to the patient. The FHS, by its turn, nowadays is deeply involved in discussions about humanization of care and how to articulate community participation in the policy development of healthcare strategies. In conclusion, political and budget issues are relevant in both countries, but the focus must remain on patient autonomy and participation as a way to expand the quality of a health care system truly committed to the social welfare. Furthermore, each society poses unique health care challenges. In confronting this complex and sensitive issue, it is essential to reflect on the experiences of both countries and to use the lessons learned for optimizing patient care.