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Teaching and learning about empowerment in family medicine. Dr. Yonah Yaphe Department of Family Medicine Sackler Faculty of Medicine Tel Aviv University, Israel Presentation to Bled Course 2007. Objectives. At the end of the presentation the participant will:

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Teaching and learning about empowerment in family medicine l.jpg

Teaching and learning about empowerment in family medicine

Dr. Yonah Yaphe

Department of Family Medicine

Sackler Faculty of Medicine

Tel Aviv University, Israel

Presentation to Bled Course 2007

Objectives l.jpg

  • At the end of the presentation the participant will:

  • Understand the definition of empowerment

  • Know how this applies to family medicine

  • Know the limits of the concept

  • Appreciate how the concept can be taught to patients and students

  • Value the promotion of patient empowerment

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  • Empowerment is:

  • A feeling of mastery or control arising from participation in dcision making or policy setting

  • A way of strengthening ourselves and others

  • A state of mind consisting of power, worth or self-esteem

  • Allowing people to reach their potential by removing obstacles

  • It can be facilitated but not bestowed on an individual or community

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Individual empowerment

  • Enhances critical consciousness

  • belief in self efficacy

  • awareness of problems and their solutions

  • personal competence in solving these problems

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Community empowerment

  • Enhancement of community resources

  • Leadership development

  • Communication resources

  • Community support network

  • Mobilize resources to adress common concerns

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Organizational empowerment

  • Enhance community based organizations

  • Protect promote and advocate the rights of the powerless

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Methods to EMPOWER

  • Educate and train

  • Media use and advocacy

  • Public education and participation

  • Organizing associations and unions

  • Work training and microenterprise

  • Enabling services and support

  • Rights protection and promotion

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Measuring empowerment

  • Meaning – the value attributed to a goal or purpose

  • Competence – self efficacy, the belief in the capability to perform the activities with skill

  • Self-determination – having the choice to initiate and regulate actions

  • Impact – the feeling that one can influence outcomes

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Why do we need empowerment

  • Respecting patient autonomy

  • Better outcomes with patient involvement

  • All healing is self- healing

  • Limited resources

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Sources of doctors’ power

  • Knowledge

  • Wealth

  • Status

  • Access to resources

  • Right to make decisions

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Sources of patients’ power

  • Ability and right to choose medical services

  • Ability to pay

  • Wealth, status, knowledge

  • Right to accept or refuse treatment

  • Threat of departure, censure, legal action

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Empowerment in primary care

  • Providing adequate information for participation in decision making

  • Creating an atmosphere that supports asking questions, challenging and making decisions

  • Empowerment or enablement? Is there a power difference?

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Effects of empowerment

  • Patient centeredness promotes:

  • Diagnostic accuracy

  • Good therapeutic outcomes

  • Patient and provider satisfaction

  • Improved communication

  • Reduced costs

  • Reduced legal actions

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Teaching doctors about empowerment

  • Early clinical exposure: Seeing the patient as a person and not as a disease

  • Learning the value of the unique personal narrative

  • Building the physician’s self esteem and self-confidence

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Video Demonstration

  • 60 year old widow

  • Diffuse limb pain, insomnia, tearfulness

  • Mother and sister with osteoporosis

  • Referred to orthopedic surgeon for advice regarding limb pain

  • Referred to bone density measurement

  • Test not covered by insurance

  • Referred to clinic manager to approve test

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Reflections on video

  • Parallel suffering of doctor and patient

  • The illness, the relationship, the system

  • Anger, frustration, powerlessness

  • Limb pain, depression, loss

  • Immigration, displacement, reintegration

  • Need for support and encouragement

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Empowering doctors

  • Teaching patient centered care

  • Teaching narrative medicine

  • Teaching about the context

  • Learning explanatory models

  • Simulation for skills training

  • Group support

  • Observation of actual practice

  • Practicing skills with feedback

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How GP’s empower patients

  • Addressing needs and expectations

  • Educating and informing about diagnosis

  • Offering information about diagnostic and treatment choices

  • Preparing for contact with secondary care

  • Encouraging demands for respect and information

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Populations with special needs

  • Women

  • Ethnic minorities

  • Handicapped

  • “Anyone else besides adult males from the same social class from the dominant culture”

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Patients empowering patients

  • Self help groups

  • Internet

  • Self education

  • Lobby for research

  • Educating doctors

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Society empowering patients

  • Patient charters of rights

  • Patients’ rights legislation

  • Safety, informed consent, free choice, respect

  • Public education and mass media

  • Health administrators informing employees of patients’ rights

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The challenge of empowerment

  • How does this affect the nature, goals and tasks of medicine

  • How does this affect our daily practice and the teaching of medicine?