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Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine

Principles of Family Medicine Shared Decision Making and Patient Empowerment. Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine. Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net. Our experiences as patients: did you ever feel powerless?.

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Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine

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  1. Principles of Family Medicine Shared Decision Making and Patient Empowerment Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net

  2. Our experiences as patients: did you ever feel powerless?

  3. Objectives • At the end of this session the participants will be able to; • discuss thedefinition 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

  4. 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

  5. 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

  6. Why Patient Empowerment? • Patients and physicians committed to joint decision-making • Patients research own health conditions • Patients today expect physicians to be team leaders and to provide clinical and educational support • Physicians are the lead source of information, the most trusted source, and the source most likely to catalyze positive behavior change Magee, Relationship-Based Health Care in the US, UK, Canada, Germany, S. Africa, and Japan, 2003

  7. 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

  8. 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

  9. The Power/Relationship Graph Keep Power Share Relationship Transaction Partnership http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck

  10. Problem Solving Keep Impose Dictate Power Compromise Common ground Share Relationship Transaction Partnership

  11. Countries Keep USA Japan France China Russia Power Germany UK Italy Sweden Share Middle east Relationship Transaction Partnership

  12. How is it with you? * Use this scoring table to calculate your own total SDM scores according to the distributed questionnaire.

  13. 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

  14. 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

  15. 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

  16. Model for Clinical Problem Solving & ISDM Presenting concern “patient’s story” DOCTOR - PATIENT COMMUNICATION Identify choices Establish pt’s role in decision making Hypothesis Step 1 Step 2 History and physical exam Review pt’s preference for information Step 3 Present evidence Identified problem or diagnosis Step 4 Respond to pt’s ideas, concerns and expectations re: management Step 5 Management / treatment Assess partnership (review previous steps) Step 6 Negotiate a decision Step 7 Agree on an action plan Step 8 Follow-up

  17. Disempowered Not involved No dialogue Feeling vulnerable No Voice in the System No Partnership / 20

  18. Empowerment allows our relationships to grow in strength / 20

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