Teaching and learning about empowerment in family medicine

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

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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

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Organizational empowerment

• Enhance community based organizations
• Protect promote and advocate the rights of the
  powerless

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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

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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

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Why do we need empowerment

• Respecting patient autonomy
• Better outcomes with patient involvement
• All healing is self- healing
• Limited resources

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Sources of doctors power

• Knowledge
• Wealth
• Status
• Access to resources
• Right to make decisions

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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

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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?

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Effects of empowerment

• Patient centeredness promotes
• Diagnostic accuracy
• Good therapeutic outcomes
• Patient and provider satisfaction
• Improved communication
• Reduced costs
• Reduced legal actions

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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 physicians 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

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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

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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

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How GPs 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

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Populations with special needs

• Women
• Ethnic minorities
• Handicapped
• Anyone else besides adult males from the same
  social class from the dominant culture

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Patients empowering patients

• Self help groups
• Internet
• Self education
• Lobby for research
• Educating doctors

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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

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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?