Transcript P2 - aile.net
Shared Decision Making in Family Medicine
Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847 1 / 18
Our experiences as patients: did you ever feel powerless?
2 / 18
Objectives
• At the end of this session the participants will be able to; – discuss the definition of patient empowerment – discuss the status of patient empowerment in FP – explain the need for patient empowerment – explain the power/relationship graph – discuss the reasons of powerless patients – explain how to empower patients 3 / 18
What is it?
• an individual being an active member of his/her disease management team Laura E. Santurri. Patient Empowerment: Improving the Outcomes of Chronic Diseases Through Self-Management Education. http://www.case.edu/med/epidbio/mphp439/Patient_Empowerment.htm
4 / 18
The idea behind
• Patients cannot be forced to follow a lifestyle dictated by others. • Preventive medicine requires patient empowerment for it to be effective. • Patients as consumers have the right to make their own choices and the ability to act on them 5 / 18
Why Patient Empowerment?
Remember the “patient centered clinical method” • Evaluating both the disease and the illness experience • Understanding the whole person • Finding
common ground with the patient
about the problem and its management • Incorporating prevention and health promotion • Enhancing the doctor-patient relationship • Being realistic 6 / 18
Why Patient Empowerment?
• • Only 9% of consultations with surgeons and primary care physicians meet full criteria for informed decision making.
Braddock JAMA 1999
• Distinguishing elements of shared decision making occurred in 0-11% of audio taped patient interviews with general practitioners.
Elwyn 2001 “..
Checking of understanding, and the involving of patients in decision making .. are rarely demonstrated” [in video taped consultations submitted for MRCGP examination].
Campion BMJ 2002
7 / 18
Why Patient Empowerment?
“People whose lives are affected by a decision must be a part of the process of arriving at that decision.” –John Naisbitt,
Megatrends
8 / 18
Keep
The Power/Relationship Graph
Power
Share
Relationship
Transaction Partnership http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck 9 / 18
Problem Solving
Keep
Impose Dictate Power
Share
Compromise
Transaction
Common ground Relationship
Partnership 10 / 18
Countries
Keep
USA Power
Share
China UK Italy Middle east Japan France Russia Germany Sweden Relationship
Transaction Partnership 11 / 18
Why is the concentration of power in this relationship with physician?
• Education • Professional status/authority • Knowledge • Skills • Expertise • Experience • On familiar territory • GATEKEEPER TO HEALTHCARE SYSTEM 12 / 18
Why is the concentration of power in this relationship with physician?
• Patient is sick, weak, vulnerable, not feeling fully oneself… • Patient may be afraid • Patient in a state of dependency • Lack of medical knowledge • Lack of knowledge on the “system” and how it works • Unfamiliar environment 13 / 18
Benefits of Patient Empowerment
• • • Learning from our patients Taking a proactive role Providing a support & information service to our patients and staff • • • Complaint Resolution Negotiation & Mediation Building trust 14 / 18
Presenting concern “patient’s story” Model for Clinical Problem Solving & ISDM Hypothesis Step 1 Identify choices DOCTOR - PATIENT COMMUNICATION Establish pt’s role in decision making
Step 2
History and physical exam Review pt’s preference for information
Step 3
Identified problem or diagnosis
Step 4
Present evidence Respond to pt’s ideas, concerns and expectations re: management
Step 5
Management / treatment Assess partnership (review previous steps)
Step 6
Follow-up Negotiate a decision
Step 7
Agree on an action plan
Step 8 15 / 18 *ISDM: Informed Shared Decision Making
Disempowered Not involved No dialogue No Voice in the System Feeling vulnerable No Partnership
16 / 18
Some useful hints before finishing
• The skilled family physician can spend 10 minute with a patient and the patient feels it was 20 minutes • Even the busiest physician can accomplish wonders in a few minutes by indicating that their full attention is on the patient • Please conclude every interview with the statement “is their anything else bothering you that we have not discussed?” • Rather than assuming that the patient have understood the instructions, ask them to repeat as they understood • Use the patients name or ask him what he prefer to be called as • Use “how can I help you? Rather than “what brings you here today?” 17 / 18
Empowerment allows our relationships to grow in strength
18 / 18