The shift from physician-centric medication (biomedical model) to patient-centric medication (patient empowerment model of care)
Introduction
The shift from physician-centric medication (biomedical model) to patient-centric medication (the patient empowerment model) was due to the challenges facing by health care providers all over the world, especially in increasing in health care demand, pressure in providing quality services, and costs. The shift of the collaboration also enhanced by technology advancement (e.g. technologies facilitate the collaboration by using Apps, Smartphone, wearing equipment), personalized learning system and the active role of the patients. These collaboration resulted in saving money, deepened the relationship between physicians and patients, increasing their understanding, and lower the cost in health care.
This article will focus on the patient’s duty – to become a more active consumer and producers by patient empowerment concept, and the knowledge management, and to examine how these concepts can be improved our health.
Differences
between the two models:
“In the
past, patients were supposed to be compliant (obedient) with a health care
professional’s directives — physician-centric medication (biomedical
model). "In this model, when a treatment
plan fails, it is often the responsibility or the fault of the patient. Persuasion and manipulation (coercion) are
the primary communication strategies for attempting to make patients manage
their illnesses.” Patients only follow the
instructions and suggestions given by the Physicians, communications between
them was limited and one-way communication occurred in the past. Physician spent less time to understand their
patient’s needs, and patients didn’t express their concern of the illness. Each visit time sometimes may less than 1
minute, as physicians just asking their symptoms rather than understand
their illness, and given the similar medicine for patients with similar
symptoms.
However, in the patient-centric medication (empowerment model), "the term used is adherence. Adherence implies a contract between patients
and providers in whom joint responsibility is taken for achieving agreed-upon
outcomes. In the empowerment model, health care professionals respect the
patient and assist the patient in making decisions in ways that have meaning to
the patient. Patient autonomy is seen as
relational rather than independent. Patients are encouraged to act autonomously
through shared information and mutual collaboration in decision making.
Understanding how patients view their illnesses and treatment has been shown to
be positively related to treatment adherence and produces better outcomes". Two-way communication rather than one-way communication
occurs in this relationship.
Patient-centric medication (empowerment model)
source: http://www.biomedcentral.com/1472-6920/5/34/figure/F1?highres=y
Case:
The following case has shown the importance of an active
patient by two-way communication and discussion with their physician, thus improved patient’s health by sharing and
better understanding.
Patient
A with
Crohn’s Disease and who has had longstanding abdominal pain and
bloating. She reported to her physician that she likes drinking a large amount of caffeinated
beverages, including coffee, soda, etc. every day. Her physician believed that the
pain was due to her lifestyle and as she drank a lot of
caffeinated products. However, patient A did
not think that there was any association between her
symptoms and caffeine intake. After discussion, patient
A agreed that to
reduce the consumption from two to five cups per day to one or
two. During a test period
of just over two weeks, her abdominal pain decreased significantly. Her pain returned after she
resumed her previous behavior (see the exhibit “Daily Caffeine Intake and
Abdominal Pain Score”). The data helped her
recognize the role caffeine played in her pain.
Exhibit 1: Patient
experiences with the Personalized Learning System: Interventions to
Reduce Variation-
Source:
Heather,
K., Jeremy, A., Shehzad, S., Lan, E., Peter, M. (2 Oct 2013). A Personalized Learning System for Improving
Patient-Physician Collaboration. Retrieved from http://blogs.hbr.org/2013/10/a-personalized-learning-system-for-improving-patient-physician-collaboration/
Shift of collaborative practices: “Patient Empowerment”:
Patient empowerment
in the health care context means to promote autonomous self-regulation so that
the individual’s potential for health and wellness is maximized. Patient empowerment begins with information and education which included seeking information about one’s own illness or condition via the website, TV, reading medical magazines, reports, attending
different kind of health care workshops hosted by hospitals (for example,
different heath care workshops and training program have been hosted by Hong Kong
Sanatorium Hospital for public in Hong Kong) or professional medical initiations. Patients actively participating in their treatment decisions, according to their culture,
risk tolerance, etc. Empowerment which required patients to take care of themselves and make choices
about care from among the options identified by the doctor.
The goal of patient
empowerment is to build up the capacity of patients to help them to become
active partners in their own care, to enable them to share in clinical decision
making, and to contribute to a wider perspective in the health care system. The reason was Health care professionals always underestimated a patient’s desire for and ability to cope
with information. In addition, consultation times are limited, thus insufficient time to fully explain
the condition and the treatment choices by them. By patient empowerment and knowledge
management, they can achieve necessary
treatment. Patients have opportunities to consider in medical decision, to ask
further questions (e.g. to prepare patient's tool-kit during each visit), and to discuss it with their family others for further advice. The critical information about the patient’s symptoms and quality of
life in a way that is currently unavailable in traditional episodic
chronic-care management.
Therefore Patient centeredness
is one of the key dimensions for improvement, thus made the shift from
physicians-centered to patient-centered model.
The Knowledge informs
decisions and actions and empowered patients :
There were two types of knowledge, one is Explicit
knowledge (Polanyi, M. (1967)). Documented information that can facilitate
action by Formal or codified, documents, reports, policy manuals, white papers,
standard procedures, databases, books, magazines, and journals (library). Regular data collection (or data tracking ), real-time review of
graphical displays of the data using statistical process control methods, and
documentation of observations made in reviewing the data all help the patient
and provider understand the extent of day-to-day variation in symptoms and
learn from changes in symptoms, behavior, or the introduction of a new
medication.
Technology (included database, web), increase in
information, globalization, demographics, economics (knowledge economy) and the
quality relations are drivers of the Knowledge Management Practices
which leads the shift in the relationship between the physicians and patients (Brown
J.S. & Duguid (1991)).
Another type is Tacit
Knowledge. It included Methods (conversations,
Q&A, capturing, advising), place
(workshops, conferences,
on-site, demonstrations, ) and Technology
(telephone, e-mail, video conference,
chat rooms, bulletin boards, on-line forums, blogs, micro blogs, social network
sites).
Knowledge Management Practices also included collaboration,
dialogues, conversations, sharing, exchanges among each other, candor, freedom
of expressions, trust, safety, honesty conversation, transparency, openness, and
collective, not only individual benefit by eliciting methods, like conversations,
discussions, dialogue, questions
& answers, problems & solutions, after-action reviews, lessons learned, capture, document,
interview, record, etc.
As mentioned in the above, patent's empowerment and active participation is caused by the process of knowledgeable management.
Collaborative Model in Knowledge Management:
Collaborative Model - Physicians and patients are,
at the same time, producers and consumers of knowledge. Instructional methods based on teams of working
together toward common goals and knowledge is exchanged in the form of help items. Knowledge sharing and transfer requires trust,
trust usually requires initial face-to-face and open sharing. Enhance trust in knowledge sharing and accountability
to performance rather than rules encourage knowledge sharing. Knowledge is changing at an accelerating
rate. It takes a community of people to
keep up with new concepts, practices, and technology.
Four sides of knowledge management are culture,
technology, economic, collaboration, cooperation, networking which enhanced the active roles and increase the duties of patients.
We understand that the key elements of
empowerment are knowledge, skills, and self-responsibility of patients. To ensure the success of patient empowerment,
enhancement of the working partnership, collaboration and decision marking between patients and health care professionals are both important. Physicians need to communicate and spend more time with their patient,
try to find out what wrong with them, building up a good
clinician-patient relationship (not only the relationship as customers and providers). The effective collaboration of knowledge sharing depend communication between
them. Trust, dialogue are the foundation for the relationship building. As a result, they will both benefit in the
sharing of information and experiences.
Physicians provided treatment options, risks by the evidence based, and
patients offer their experience with the medical conditions to their health
care professionals, which enhanced the evident-base data bank.
Another way in empower patients is making use of information technology (e.g.like wearable devices, makes visits and telephone encounters more productive by
offering much richer information about experiences related to the illness etc.) in disseminate knowledge, establishing
standards for disease management, and promotion of clinical research which also increased the benefit of the health care
provided and
empowered the patients.
In addition, educating patients
in safety practices, for example knowledge of medication that could help to prevent
medication errors, will create a market that demands and supports safety.
Apart from
the above, the shift and enforced the patient’s duties is the process of Knowledge
management. Knowledge management is a process
to enable people to develop a set of practices to create, share and use the
knowledge to advance goals (Petrides,
L.A. & Nodine,T.R (2003)). Knowledge which then motivated
patients collaborate with their physicians to develop a learning plan that is
designed to help them establish shared goals and clearly articulate their
hypotheses about which treatments and lifestyle modifications will improve
patient symptoms.
Patients are now playing a more active role by sharing their experience and
develop a practice with their physicians, in achieved and advance the goals –
to improve their health and to reduce the health care cost.
photo courtesy: http://hellohealth.com/tag/shahid-shah/
Conclusion:
In future, we believed that patients are more important to play
an active role in pushing the health care system to improve, and being involved
in our own care by empowerment and effective knowledge manage.
photo courtesy:www.medicaltourismmag.com
References:
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