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Teaching and learning about empowerment in family medicine

Teaching and learning about empowerment in family medicine

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Teaching and learning about empowerment in family medicine

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  1. Teaching and learning about empowerment in family medicine Dr. Yonah Yaphe Department of Family Medicine Sackler Faculty of Medicine Tel Aviv University, Israel Presentation to Bled Course 2007

  2. Objectives • At the end of the presentation the participant will: • Understand the definition of empowerment • Know how this applies to family medicine • Know the limits of the concept • Appreciate how the concept can be taught to patients and students • Value the promotion of patient empowerment

  3. Definition • Empowerment is: • A feeling of mastery or control arising from participation in dcision making or policy setting • A way of strengthening ourselves and others • A state of mind consisting of power, worth or self-esteem • Allowing people to reach their potential by removing obstacles • It can be facilitated but not bestowed on an individual or community

  4. Individual empowerment • Enhances critical consciousness • belief in self efficacy • awareness of problems and their solutions • personal competence in solving these problems

  5. Community empowerment • Enhancement of community resources • Leadership development • Communication resources • Community support network • Mobilize resources to adress common concerns

  6. Organizational empowerment • Enhance community based organizations • Protect promote and advocate the rights of the powerless

  7. Methods to EMPOWER • Educate and train • Media use and advocacy • Public education and participation • Organizing associations and unions • Work training and microenterprise • Enabling services and support • Rights protection and promotion

  8. Measuring empowerment • Meaning – the value attributed to a goal or purpose • Competence – self efficacy, the belief in the capability to perform the activities with skill • Self-determination – having the choice to initiate and regulate actions • Impact – the feeling that one can influence outcomes

  9. Why do we need empowerment • Respecting patient autonomy • Better outcomes with patient involvement • All healing is self- healing • Limited resources

  10. Sources of doctors’ power • Knowledge • Wealth • Status • Access to resources • Right to make decisions

  11. Sources of patients’ power • Ability and right to choose medical services • Ability to pay • Wealth, status, knowledge • Right to accept or refuse treatment • Threat of departure, censure, legal action

  12. Empowerment in primary care • Providing adequate information for participation in decision making • Creating an atmosphere that supports asking questions, challenging and making decisions • Empowerment or enablement? Is there a power difference?

  13. Effects of empowerment • Patient centeredness promotes: • Diagnostic accuracy • Good therapeutic outcomes • Patient and provider satisfaction • Improved communication • Reduced costs • Reduced legal actions

  14. Teaching doctors about empowerment • Early clinical exposure: Seeing the patient as a person and not as a disease • Learning the value of the unique personal narrative • Building the physician’s self esteem and self-confidence

  15. Video Demonstration • 60 year old widow • Diffuse limb pain, insomnia, tearfulness • Mother and sister with osteoporosis • Referred to orthopedic surgeon for advice regarding limb pain • Referred to bone density measurement • Test not covered by insurance • Referred to clinic manager to approve test

  16. Reflections on video • Parallel suffering of doctor and patient • The illness, the relationship, the system • Anger, frustration, powerlessness • Limb pain, depression, loss • Immigration, displacement, reintegration • Need for support and encouragement

  17. Empowering doctors • Teaching patient centered care • Teaching narrative medicine • Teaching about the context • Learning explanatory models • Simulation for skills training • Group support • Observation of actual practice • Practicing skills with feedback

  18. How GP’s empower patients • Addressing needs and expectations • Educating and informing about diagnosis • Offering information about diagnostic and treatment choices • Preparing for contact with secondary care • Encouraging demands for respect and information

  19. Populations with special needs • Women • Ethnic minorities • Handicapped • “Anyone else besides adult males from the same social class from the dominant culture”

  20. Patients empowering patients • Self help groups • Internet • Self education • Lobby for research • Educating doctors

  21. Society empowering patients • Patient charters of rights • Patients’ rights legislation • Safety, informed consent, free choice, respect • Public education and mass media • Health administrators informing employees of patients’ rights

  22. The challenge of empowerment • How does this affect the nature, goals and tasks of medicine • How does this affect our daily practice and the teaching of medicine?