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 1 / 18 Our experiences as patients: did you ever feel powerless? 2 / 18 Objectives • At the end of this session the participants will be able to; – – – – – – discuss the definition 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 3 / 18 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 4 / 18 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 5 / 18 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 6 / 18 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 7 / 18 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 8 / 18 The Power/Relationship Graph Keep Power Share Relationship Transaction Partnership http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck 9 / 18 Problem Solving Keep Impose Dictate Compromise Common ground Power Share Relationship Transaction Partnership 10 / 18 Countries Keep USA China Power UK Italy Share Japan France Russia Germany Sweden Middle east Relationship Transaction Partnership 11 / 18 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 12 / 18 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 13 / 18 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 14 / 18 Presenting concern “patient’s story” Model for Clinical Problem Solving & ISDM DOCTOR - PATIENT COMMUNICATION Hypothesis Step 1 Establish pt’s role in decision making Identify choices History and physical exam Identified problem or diagnosis Management / treatment Follow-up Review pt’s preference for information Step 4 Present evidence Respond to pt’s ideas, concerns and expectations re: management Assess partnership (review previous steps) Negotiate a decision Step 7 Agree on an action plan Step 8 Step 2 Step 3 Step 5 Step 6 15 / 18 *ISDM: Informed Shared Decision Making Disempowered Not involved No dialogue No Voice in the System Feeling vulnerable No Partnership 16 / 18 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?” 17 / 18 Empowerment allows our relationships to grow in strength 18 / 18