Tuesday, June 21, 2011

Human Centered Health Home: Reflecting on Patient Values, Goals and Dreams

During the last major process of the patient-physician engagement in the Human Centered Health Home (HCHH)- Reflecting, a primary aspect involves patient goals.  The patient relates with the physician to remain in line, or re-align with, personal values, goals and dreams.  Various aspects of these elements may be clarified over time in the context of the patient-physician relationship   During each engagement, either party may seek to clarify how health or health problems may relate to long and/or short term life goals.  While reflecting near the end of the encounter, long and short term values, goals and dreams of either or both parties may be reviewed to facilitate better short and/or long term decision making.  Past posts have given specific examples and future posts will give more examples of how to do this.

The physician has already shared their perspective with the patient using a process such as "get, give, merge and go." (see explanation here)  The patient now has the satisfaction of having a mutually agreeable perspective relative to their chief concern since they participated competently with the physician.  The physician is relating to the content of their clinical note for recording recommendations and agreed to decisions already discussed.  They may be using the format of the eventual final note to guide their comments and give the engagement another reportable element.

There may be a lot of probabilistic commentary during this section, as the physician comments on the probabilities that the patient will achieve their goal(s) using various diagnostic, therapeutic and educational strategies.  The patient may clarify their goal(s) as this discussion progresses.  The driving value of most concern to the patient may be mentioned, clarified and recorded in the note as having influenced the decision process to be able to remind the participants of that value and its importance.  Reflecting on patient (and physician) values in recorded media (the medical record) enriches the human alignment potential for both parties.

These values may be physical, intellectual, emotional and/or spiritual relating to any aspect of the biopsychosocial model, from the biosphere to the subatomic level.  The physician must remain mindful of patient safety and costs throughout this element of the engagement.  They may also be reflecting on their own biopsychosocial values and their own humanity during the discussion and while assuming various roles throughout the relationship with the patient.  The vast array of considerations is dependent on respectful, honest communication by both parties and timely recording of key components of the discussion and decisions.

This synthesis of phenomena is usually concurrent with record keeping, including the filling out of forms that relate to elements of the shared decisions (lab slips, prescriptions, encounter forms, physical therapy orders, etc.) which usually are the purview of the physician, but may change via use of the Electronic Medical Record (EMR) and the Personal Health Record (PHR).  The distraction potential during this content rich reflecting period is high, with patients often comforted enough by the process to suddenly bring up more problems for their family physician to consider, instead of celebrating the progress made as the physician might desire.

The mutual respect of the dyad may need a refreshing nudge at this time to stay focused on the main purpose of the encounter and the ongoing nature of the relationship.  Shifting back to roles of "human to human" may be one useful strategy that enables conclusion of the "clinical" engagement and a moment to honor their shared humanity.  This process is very complex and requires training and trial and error to achieve comfort and confidence.  Humans can do it as they remember to honor their shared humanity.  An over emphasis on patient or physician roles could mire the engagement in sludge, resulting in dissatisfaction for both.

Remember to GO HUMAN in the Human Centered Health Home.

1 comment:

  1. Thanks for including the blog on your radio show. I listened but couldn't get a password from the site to register and chat.

    I have one clarification, the ACTH was less than 5, the < got kind of lost next to the hyphen.