2. / 181 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

3. / 182 Our experiences as patients: did you ever feel powerless?

4. / 183 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

5. / 184 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

6. / 185 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

7. / 186 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 Why Patient Empowerment? Remember the “patient centered clinical method”

8. / 187 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 Empowerment?

9. / 188 “People whose lives are affected by a decision must be a part of the process of arriving at that decision.” –John Naisbitt, Megatrends Why Patient Empowerment?

10. / 189 Power Relationship Partnership Transaction Keep Share The Power/Relationship Graph http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck

11. / 1810 ImposeDictate CompromiseCommon ground Problem Solving Power Relationship Partnership Transaction Keep Share

12. / 1811 USAJapan China Sweden UK Italy Middle east France Russia Germany Countries Power Relationship Partnership Transaction Keep Share

13. / 1812 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 physician?

14. / 1813 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 Why is the concentration of power in this relationship with physician?

15. / 1814 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. / 1815 Follow-up Management / treatment Presenting concern “patient’s story” History and physical exam Hypothesis Identified problem or diagnosis Identify choices Review pt’s preference for information Present evidence Respond to pt’s ideas, concerns and expectations re: management Assess partnership (review previous steps) DOCTOR - PATIENT COMMUNICATION Establish pt’s role in decision making Agree on an action plan Negotiate a decision Model for Clinical Problem Solving & ISDM Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 *ISDM: Informed Shared Decision Making

17. / 1816 Feeling vulnerable Not involved No dialogue Disempowered No Partnership No Voice in the System

18. / 1817 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?”

19. / 1818 Empowerment allows our relationships to grow in strength