Doing MDM & SDM in Practice

1. Doing MDM & SDM in Practice

2. You are Sarah, a 35 year-old, mother of 3, and you are seeing your primary care clinician of many years. Not only does your clinician see you, but has taken care of your extended family for many years. Your parents are in poor health, living with multiple chronic conditions each and you have helped them manage clinic visits, hospitalizations, and worsening health in their home over the years. You have done this with little support from yourhusband, and your kids are still too young to lend a hand. Additionally, you have type 2 diabetes, hypertension, and have struggled with losing weight for many years. These are the conditions that you are seeing your clinician for today. You also smoke regularly as a mechanism to cope with the stress, although you have tried to quit multiple times. You know going into this visit that your clinician is again going to bring up the fact you should lose some weight and stop smoking. You also feel that your life is slowly slipping away from you, and struggle to find meaning in activities that previously seemed important to you.

3. Activity

4. Pair up. Decide which person will play “patient” and the other “clinician.” • Patients – take time to read Sarah’s story and assume your role as her. • Clinicians, when the patient is ready, begin the conversation with Sarah by asking “What can I do for you today?”

5. Debrief

6. Evidence synthesis Observation clinical encounters Initial prototype Designers Study team Patient advisory groups Clinicians Stakeholders Modified prototype Field testing \ Final Communication Tool Evaluation (trial)

7. Life Burden of treatment Workload access use self-care Outcomes Capacity Burden of illness Scarcity Shippee N et al JCE 2012

8. The Burden of Treatment • Emotional Problems • Role and activity limitations • Financial challenges • Confusion about medical information • Systemic problems Eton et al. 2012

9. Biography Realization of Work Resources Environment Social Network

10. Evidence synthesis Observation clinical encounters Initial prototype Designers Study team Patient advisory groups Clinicians Stakeholders Modified prototype Field testing \ Final Communication Tool Evaluation (trial)

11. Activity

13. Debrief

14. Activity

15. LeBlanc A et al. JAMA Int Med 2015

16. Debrief

19. Boehmer KR, et al. 2016, BMC Health Serv Res.

20. Debrief

21. Evidence synthesis Observation clinical encounters Initial prototype Designers Study team Patient advisory groups Clinicians Stakeholders Modified prototype Field testing \ Final Communication Tool Evaluation (trial)

37. Two Communicative Strategies • Remove ambiguity by making definite • Define, Assess, Interpret, Diagnose • Make ambiguity productive for the people involved • Invention, meaning making

38. Life | Healthcare

39. Where do you find joy?