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Shared Decision Making in Family Medicine

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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Shared Decision Making in Family Medicine

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  1. 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 / 18

  2. Our experiences as patients: did you ever feel powerless? / 18

  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 / 18

  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 / 18

  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 / 18

  6. 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 / 18

  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 / 18

  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 / 18

  9. The Power/Relationship Graph Keep Power Share Relationship Transaction Partnership / 18 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 / 18

  11. Countries Keep USA Japan France China Russia Power Germany UK Italy Sweden Share Middle east Relationship Transaction Partnership / 18

  12. 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 / 18

  13. 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 / 18

  14. 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 / 18

  15. 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 / 18 *ISDM: Informed Shared Decision Making

  16. Disempowered Not involved No dialogue Feeling vulnerable No Voice in the System No Partnership / 18

  17. 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 / 18

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

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