Patient Centered Care Flashcards
(43 cards)
Problems with Clinician Centered Care
Balance of power to the Doc
Doc took charge and focused on Sx to determine Dx
Too closed ended - Pt interrogation
Pt experience was ignored/discouraged; prevented pertinent information
Detached perspective
Biopsychosocial Model
Bio medicine to narrow.
Illness is a complex interaction of biological, psychological, social factors
-George Engal
Picker’s Eight
Respect
Coordination/Integration of care
Information and Education
Physical Comfort
Emotional Support
Involvment of Fam/Friends
Continuity and Transition
Access to Care
Patient centered care
Patients want to be seen as individuals, to understand their concerns, emotions, and life challenges.
This models encourages expression of what is important to them and to recognize the importance of the patient’s expressions of personal concerns, feelings and emotions.
Relationship-centered Care
Expansion of Pt Centered Care and biopsychosocial model
Considers all illness, care, and healing occurs in the setting of relationships - with self and others.
Emphasizes nature and quality of these relationships are central to healthcare.
Includes relationship b/w caregivers and the patient’s families, relationship among the healthcare team, relationship with self.
REspectful and responsive care with Pt pref, values, needs ensures that Pt values guides all clinical desicions
Patient Assessment Overview
Prep
Hx taking
PE
Assessment
Plan
Documentation and presentation
Preperation
Pt name
CC
Review past/current medical Hx
Tool
Special accomdations
ID Accomodations
Health Hx
ID Data
Reliable Source
CC
HPI
PMH
Social Hx
Fam Hx
ROS
PE Components
General Survey
VS
Skin
HEENT
Neck
Back
P./A. Thorax and Lungs
Breast, Axillae, Lymph nodes
CV
Abd.
Lower Extremities
NS
Genital`/Rectal Exam PRN
Assessment
Analyze Findings
Use sound reasoning to ID problems.
Requires DDx
Plan
For each problem, specify next steps.
ABX? Tests? FUV?
Documentation
A clear, well organized record is #1 in providing excellent care.,
Be accurate, thorough, and clearly express reasoning for your assessment and plan.
Oral Presentation
Demonstrate ability to synthesize lg amounts of data, communication skills, and how you see the Pt as a person.
Medical interview Intro
Most important and difficult skill.
Over 200,000 interviews.
Defined as the process of gathering and sharing info in the context of a Trustworthy Relationship
Interview is one of the most effective diagnostic tools.
Medical interview - Goal #1
Establish a meaningful and caring Relationship with the Pt
Make sure that they feel head, understood, and cared for
Ensure what they are hoping to achieve is acknowledged
Respond to their Emotions
Medical interview - Goal #2
Be a rigorous Diagnostician - Carefully collect data
Thoroughly collect all data necessary to generate an accurate medical assessment and plan.
Ensure Collected Data is correct and pertinent.
Smith’s Steps Summary
1, 2 - Create Rapport and Set the Adgenda
3,4, 5 - Patient -Centered Hx and Interview:
Which includes listening to Story, Eliciting and responding to emotions, and summary and transition.
6, 7, 8, 9, 10 - Clinician-Directed Hx interviewing skills (HPI, PMH, SH, FH, ROS)
Interview - Patient-Centered
Complements Clinician-centered interview.
Encourages Pt to express what is most important, including Sx
Helps to recognizes the importance of the Pt’s expressions of personal concerns, feelings and emotions.
Helps synthesize a Biopsychosocial description of the Pt.
Interview - Clinician-Centered
Clinician lead interview to gather more information to develop an accurate Dx and Plan.
Why is the Patient-centered interview so important? #1
1 Allowing the patient to tell their story is diagnostically helpful
Helps to arrive at the correct Dx more often and more quickly.
Adds physical Sx information not elicited at all in the clinician-centered approaches.
“if you listen to the Pt, they are telling you the Dx”
Why is the Patient-centered interview so important? #2
Associated with increased Pt and clinician satisfaction!
Therapeutic, and helps the Pt feel like they have been heard and understood.
Provider is given the chance to understand context of Sx
And an opportunity to express empathy and respond to the Pt’s emotions.
More meaningful relationships
Why is the Patient-centered interview so important? #3
Leads to improved Healthcare Outcomes.
IE better cancer outcomes, more compliance in Tx, and better postop or perinatal coutcomes
Why is the Patient-centered interview so important? #4
Associated with less malpractice suits
Clinician Centered Interview - Biomedical Model :(
Concerns treated as non medical data, and ignored.
Without that personal information, feelings, and emotional component, the ability to form a relationship is limited.
Leads to poor Pt satisfaction, physician frustration, and worse health outcomes overall.