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Shared Decision Making in Family Medicine. Introduction to Primary Care: a course of the Center of Post Graduate Studies i n FM. PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847. Our experiences as patients: did you ever feel powerless?. Objectives.

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slide1

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

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objectives
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

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what is it
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

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the idea behind
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

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why patient empowerment remember the patient centered clinical method
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

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why patient empowerment
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

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why patient empowerment1
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

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the power relationship graph
The Power/Relationship Graph

Keep

Power

Share

Relationship

Transaction

Partnership

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http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck

problem solving
Problem Solving

Keep

Impose

Dictate

Power

Compromise

Common ground

Share

Relationship

Transaction

Partnership

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countries
Countries

Keep

USA

Japan

France

China

Russia

Power

Germany

UK

Italy

Sweden

Share

Middle east

Relationship

Transaction

Partnership

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why is the concentration of power in this relationship with physician
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

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why is the concentration of power in this relationship with physician1
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

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benefits of patient empowerment
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

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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

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*ISDM: Informed Shared Decision Making

not involved

Disempowered

Not involved

No dialogue

Feeling vulnerable

No Voice in the System

No Partnership

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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?”

Some useful hints before finishing

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