The Patient

People are by far the most important part of health care. Here's some information about people! Know your body, and take care of it. What is the difference between patient and client?

• ownership
• self-management
• patient-centred care
• survivorship
• resources and references

 

 

 

Ownership

"Experience is not what happens to a man; it is what a man does with what happens to him" - Aldous Huxley

We need to be in control of our own bodies. So often we are told we don't have what it takes to make good decisions. "Before you start exercising/eating fibre/going on a rollercoaster, ask your doctor" is a common thing. In many ways this is designed to remove liability, which is important in today's culture, but it also has a tendency to leave people feeling more powerless than they need to. Health literacy - the understanding of our bodies and what can go wrong with them - is an important starting off spot for ownership.

People need to know:

• what to know - healthy living, risk factors, diseases and conditions
• what to do about their health (choices)
• when to seek help
• who to go to - primary care, community folks, etc
• practical skills:
  • blood pressure (how to measure your own blood pressure)
  • first aid
  • healthy eating
  • exercise

 

 

Self-Management

Self manangement is a model of care, not a 6 week program. It stresses problem solving, decision making, and patient-HCP partnerships. It is closely linked with community organizations and primary health care. Self-management does not mean 'education'. Everyone knows about smoking, but many still do.

 

Traditionally, self-management programs aimed to improve compliance, particularly around medications. But people want more. They want to be able to deal with the emotional consequences and the functional effects.

 

We need to equip patients, as well as change professional attitudes and approaches.

 

 

 

Ventura has written about self-efficacy. The strongest means of self-efficacy, and thereby ability to change, comes with skills mastery. The next most potent are modeling, social persuasion, and reinterpretation.

 

Self-management and health care

People need to be supported by health care providers and community members as they self-manage. Internet/telephone coaching is a good thing. However, HCPs are outsiders, and modeling doesn't work. Instead community members - lay people - can model and socially persuade their friends and neighbours.

We don't want to dump all responsibility on patients and then let them float off. They must remain supported.

We need to improve self-efficacy training, during training programs and during people's careers, with the whole system being impacted. If one HCP says "here's your results" and another says "'you don't need to know that" then people can get very confused.

In Australia, every health student will soon need to show competencies in self-managment. (selon Tanya Packer)

resources

• Lorig's CDSMP
• Corbin and Strauss - qualitative research.

evidence for self-management

many questions remain unanswered. we don't know what the essential interventions are, what the doses are, etc

 

UK NHS expert patient programs - 10 year report available.

 

 

 

Patient-Centred Care

 

People need to be treated with respect, given explanations of what is happening, and asked permission. Consequences of choices are good things to have.

 

• respect patient's values and preferences
• partnership
• contextual congruence
• respect for diversity
• acessibility and flexibility
• communication and education
• continuity, transition, and integration with community
• physical comfort and emotional support

 

 

Surivorship

Two groups who refer to themselves as survivors are

cancer patients, and

people who have expereinced mental health concerns

 

 

 

 

Resources and References

A 1999 issue of the British Medical Journal is thematically around patient partnership in health care.

A Feb 2008 CBC report talks about how people involved in their own care do worse...