Tuesday, October 16, 2012
Clinical Decision Making in the Human Centered Health Home
The Dr Synonymous Show October 16, 2012
Dr Synonymous reviews clinical decision making in the Human Centered Health Home (HCHH) using models of thought and care that may be used in Family Medicine.
After a person identifies that they need their physician to help with a problem, they make an appointment of one type or another. An appointment may includes human centered greeting comments, then use of SPIT, a model for considering Serious, Probable, Interesting and Treatable causes of the patients chief complaint.
Next is Identifying Information that personalizes/humanizes the patient, including a Living, Learning, Working model with physical, intellectual, emotional, and spiritual components of the patients life through CODIERS (another model).
Dr S next comments on using the Biophychosocial Model to expand the differential diagnosis further. A further filtering, expanding and narrowing process next mentioned is the consideration of systems and processes that may relate to the patients primary problem.
The dyad engages the HCHH process by Respecting themselves and each other, unconsciously committing to Protect each other, then by Connecting in a mutual problem solving dyad. As they explore the above information in the context of the patients life, the physicians life and the system in which they engage, they seek to Detect the causes of the patients misalignment (chief complaint) with their life/work plan.
The physician then undertakes a physical exam of the patient considering the differential diagnosis throughout the process.
The dyad, after the patient repositions, then shares their perspective and clarifies the assessment.
Next they share in developing a plan to Correct the situation causing the chief complaint. The plan may include Diagnostic elements such as imaging or laboratory tests, or even the test of time. It may include Therapeutic elements including dietary measures, exercise, medication, physical therapy, massage, vitamins, etc. Patient education is the last formal component of the visit followed by a human/human departing action/comment.
Each patient and physician engage differently, so models such as those mentioned may or may not be used by individuals in any clinical engagement. I like using the models, especially the HCHH process for training and personally use them in my daily practice every day.
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It was interesting to hear the thought processes going on in the physician's mind while working out a diagnosis and treatment plan. Patients really need to know this type of information. Thank you for sharing!
ReplyDeleteThanks for your comment, WarmSocks. Each clinical encounter has unique attributes, consistent with the uniqueness of each patient and physician. I enjoy model building to enhance the variability of each encounter. Thanks also for your blogging, which means so much to so many. apj
ReplyDeleteWhy is that only a few FP physicians use the HCHH model or any of the models you mentioned? Is it lack of training? Lack of interest? Lack of time? Lack of reason? Or all of the above?
ReplyDeletemas
Thanks for your comment, mas. Good questions. Each physician has their own training and experience in clinical interviewing and decision making, then they evolve over time to their favorite strategies that go with their style. No two are alike. On the HCHH: Human centering is evolving from the Human Factors Engineers toward medical practice. It'll be a while to allow it to integrate with the practice of medicine. apj
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