PFC 101 Introduction to Patient u2013 Centered Care.docx -...

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PFC 101: Introduction to Patient – Centered Care Lesson 1: Patient-Provider Partnerships for Health 1.Models of the Patient-Provider Relationship - You might notice a few things about the relationships depicted on the previous page. In some of these relationships, one person has a lot more power than the other. The relationship is hierarchical. o For example, parents make decisions for their small children because they’re not yet old enough to make choices on their own. Oftentimes, children are expected to follow their parents’ orders without questions, even if they don’t understand them. o An executive, on the other hand, has the power to make the decision, even though the advisor might have more information. This is similar to the hairstylist-customer relationship, in which the hairstylist has technical skills that the customer does not, but follows the customer’s instructions. o You might compare these power dynamics to the clinical encounter, where the patient is sick and afraid, and the provider is expert and has the ability and authority to provide treatment. - In an influential article in JAMA, Dr. Ezekiel J. Emanuel and Dr. Linda L. Emanuel proposed four models of the patient-provider relationship. Surgeon and acclaimed author Dr. Atul Gawande writes about how these models shaped his clinical style in his book Being Mortal. Here’s a quick summary: o The paternalistic model is the traditional model, in which the physician or provider is viewed as an expert authority on health care, including the values of that health care — things such as extending life, curing disease, and reducing pain. The provider plays the role of a parent or guardian, and the patient assents to the provider’s authority. o The informative model is on the opposite end of the spectrum. In this model, the provider is a technical expert who simply provides information to the patient, and the patient holds the decision-making power about his or her care. It’s similar to the hairstylist-customer relationship. This model assumes that patients know what their values and interests are, and they just need facts about their medical care to decide what to do. o In the interpretive and deliberative models , the patient may not know what matters most to him or her in a given situation. The provider serves in the role of a counselor, advisor, friend, or teacher. In the interpretive model, the provider’s role is to elicit the patient’s values. In the deliberative model, the provider takes a slightly more assertive role, helping the patient understand his or her values in the situation. In either case, the provider and the patient are on the same team, working toward the same goal, like the coach and player. 2. Traditional Model - Traditionally, health care has usually followed the paternalistic model because people thought that patients and providers shared the same, objective values in regard to health. Generally, these values were things like extending the length of life, relieving pain, and curing disease.
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