Friday, October 19, 2012

Context and Reflection in the Human Centered Health Home

“The central tasks of a physician’s life are understanding illness and understanding people.  Because one cannot fully understand an illness without also understanding the person who is ill, these two tasks are indivisible.”…McWhinney in Family Medicine

Also, a physician should understand him/her self and their own worldview.  Context is powerful in the patient-physician relationship, including that of the patient, the physician and their relationship.  Yes, the confluence of the worldviews of the patient and the physician is important.

The last post referred to clinical decision making in the Human Centered Health Home (HCHH).  After Respecting, Protecting, Connecting, Detecting, and Correcting, the dyad of patient and physician finish their engagement by Reflecting.  This may include Reflecting on the current engagement, the relationship, the decision making process, the future, etc.

Part of the Reflecting by the physician includes recording the clinical encounter note.  Eventually, this may be partly written by the patient.  Both parties may eventually have a separate note about the engagement that has a merged component and is shared for the Personalized Health Record (PHR) owned by the patient and the Electronic Medical Record (EMR), controlled by the physician.

As the "Socio-Technical Neighborhood" is further developed, audio and video elements of the note will be shared for Reflection in the PHR and the EMR.  Arrangements for confidentiality, HIPAA, and consent to use information by either party will require further clarification.  It will become more and more popular.

What do you think about the context of the patient physician engagement?  How do you like to Reflect on the engagement and the relationship? What aspects of the "Socio-Technical Neighborhood" should be developed?  Will be helpful?

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