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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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slide1

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

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
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

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
why patient empowerment
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

why patient empowerment1
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
why patient empowerment2
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
the power relationship graph
The Power/Relationship Graph

Keep

Power

Share

Relationship

Transaction

Partnership

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

countries
Countries

Keep

USA

Japan

France

China

Russia

Power

Germany

UK

Italy

Sweden

Share

Middle east

Relationship

Transaction

Partnership

how is it with you
How is it with you?

* Use this scoring table to calculate your own total SDM scores according to the distributed questionnaire.

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
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
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
slide16

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

not involved

Disempowered

Not involved

No dialogue

Feeling vulnerable

No Voice in the System

No Partnership

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