Wednesday, April 20, 2011

Human Centered Health Home (HCHH): Complexity to Simplicity While Working and Caring

Context is important in clinical encounters.  Each patients life is uniquely one of a kind.  The variables vary, driving clinical decision making to uniquely respond to each patient.  Flexibility in the context of the patient-physician relationship is expected of physicians by patients and should be extended by patients to physicians.  The dyad is engaged in the process I've outlined in previous writings about The Human Centered Health Home (HCHH), starting with Respect.

Each member of the dyad comes from a context of complexity, but desires simplicity in their communication and their relationship.  Each cares about themselves and the other, but has to work at task accomplishment within the context of their own lives.

The dyad itself is a complex human phenomena which seeks simplicity at its core, while "dancing" through facts and variables in a "trans-derivational state" of mutual exploration and sharing.  The entrainment of energies in the dyad offers other levels of biopsychosocial sharing beyond the words and gestures they manifest.  As mutual understanding allows the dyad to settle into a state of agreement, work flow shifts to tasks and processes that change the state of the dyad into separation mode. This leads to other agendas and/or forms, nods, transitional words and gestures and departure from the dyad back to individual patient and physician.

The humans in the dyad shift roles to patient and doctor, consumer and consumer coach, learner and teacher, learner and learner, and others during the engagement.  Both hope for a mutually beneficial outcome, but have some fear that it may not be what they expect.  Uncertainty abounds as to which exact path the biological or behavioral issues will follow.  The agreed to intervention(s) are intended to alter the course of a pathologic process to a healing process.  Contingencies may be offered/ negotiated for outcome variables that misalign the patient (and the doctor) with the desired outcome.

BUT, what happens if the physician is distracted with thoughts about the psychotic 25 year old man who was hearing voices and buying Percocets on the street again because that's the only thing that will quiet the voices?  The man was unwilling to go to a psychiatrist since they won't listen the way the family doctor will.  He only wanted some Ativans to stop the need to buy the Percocets.  But the doctor offered the ER where the patient could see the crisis intervention evaluation social worker to consider detox and psychiatric evaluation.  The patient refused and left the office saying, "I don't know what to do or where to go.  I thought you would understand.  I thought you would help me."  While thinking about how to be of better help to this man, the doctor is interrupted in the hallway by the office manager.  "You know he left without paying again.  He owes us $584 for visits over the last 18 months."

AND/OR what happens if the patient is distracted by the cell phone call from her sister saying that the ex brother in-law (sister's husband) is threatening again to seek custody of the kids because their daughter was expelled from school again?  She needs another $500 to pay initial attorney fees to prepare to block him.  The patient also remembers that she's supposed to try to get her birth control prescription filled by the family doctor today since she's about out of her last packet prescribed by the gynecologist after the baby was born a year ago.  She's not sure how to bring up that subject since her appointment was just made this morning when she woke up coughing and wheezing on the tenth day of a cold that seemed just yesterday to be finally ending.

The complexity of the other situations may prevent the dyad from connecting well enough to effectively relate to the problems at hand.  Their conflicted work flow may filter their caring.  A disjointed encounter may misalign them with their actual needs.  Can they find a connection point that affords a mutually beneficial outcome to this encounter?

I believe they can breathe and appreciate, in  the context of an ongoing relationship with a human base, the human dyad into a coherent connection that can overcome a distracted encounter with Simplicity.  They can start with the processes of the HCHH:  through respecting, protecting and connecting as humans first.  They can match their breathing, focus on their hearts and appreciate something beyond the dyad together.  They can follow this by  responding to feeling and content of each others general situations until a respectful connection to the meaning of their respective situations seems to exist. This connection may deliver enough Simplicity in the dyad, via coherence (a balance between the sympathetic and parasympathetic nervous systems, to allow the roles of patient and physician to emerge, stabilize and engage with a focus on the pressing issues of the clinical situation.  The complexity of the individuals may then be focused on those clinical issues, filtering out the life/ work context elements that are distracting.

With the respect established early in the relationship, they may continue to clarify roles and goals in the next/ follow-up encounter and mutually agree on the varying process of "caring" while accomplishing the tasks of the process of care.   Respectful Humans can accomplish a lot in a relationship based clinical environment.

What do you think?

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