Patient-Centered Care Part 2 of 2: Being Your Own Health Care Manager
“How can I be the best Health Care Manager for myself?”
The online world of the internet presents many opportunities to engage with information in such a way that has never been done before. Anyone with internet access can research information, find solutions to problems, assess various situations from the experience of other users, seek out persons whose interests align with theirs, etcetera. The internet is such a vast place of information, that if you are not an expert on a particular subject, the information available can be overwhelming. More so, it can be difficult at times to tease what information is relevant, valuable, trustworthy, replicable, realistic, valid, unbiased, reputable, and evidence-based.
Patients Are Health Care Managers That Are At The Center Of Their Collaborative Health Care Team
As such, it is problematic when a patient (everyone is a patient at any particular point in time, even Doctors) tries to be their own Health Care Manager without the guidance of a Health Care Professional. Remember in Part 1, I had mentioned that the patient is the center of the multidisciplinary team? Well, when a patient goes on their own to do research about a particular health issue and tries to solve it without the consult of a health professional, it can yield problematic, unintended and sometimes long-term or permanent consequences. This is however, a risk that most people do not taken into account when they go onto the open web.
Being your own Health Care Manager is about research and learning on your own; then bringing questions, issues, and recommendations to a health professional who is part of your team. You see, anyone can get information. You do not need to be specially trained in order to obtain it. What does take special training is to make relevance of that information, assign importance, synthesize it, and then output it into a product that is useable. The information is manufactured in essence, and the process that is manufacturing it, is collaborative.
Work, Work, Work
There are many different theories and frameworks that aim to have patients engage in more collaborative and meaningful ways in their health care. I know, I looked. What is challenging, is how to explain and engage a patient in this process so that they can be their own Health Care Manager in an efficient, independent way such that the patient is truly the center of care and is the one that is making empowered decisions. I advocate for patients to empower themselves and take charge of their health however, this means they must be engaged throughout. This by no means, is a passive process. It takes work. Work to research. Work to read. Work to understand. Work to clarify. Work to plan. Work to present. Work to obtain related and relevant information. Work to use that information. Work to make a decision based on the information. Work to follow through with treatment. Work to monitor and evaluate the treatment. Work to prevent. Work to be aware.
Sabrina’s Adapted Nursing Process Method For Patients: “Your Health Care Snapshot, From Your Perspective”©™
In the following steps I describe, I will use the example of a fictional patient with type II diabetes, for two reasons. First, obesity is related to the development of type II diabetes. Second, obesity is prevalent in developed countries and is considered an epidemic in some places. Therefore, the type II diabetes example I present, will be relevant and affect the lives of most people who read this article either directly or indirectly. I use the example from the point of view of the self but, is applicable if you are responsible for the care of someone else.
Step 1: Know Yourself (Health History)
The aim of this is to come up with a sheet of paper that summarizes everything that is happening in your health and that is a concern to you in the present moment of time. Patients do not have complete medical records of themselves to look at, so you will first have to make a list of all the health issues that you have. In this step, you are making a list of all your health concerns, so order does not matter.
Step 2: Making Connections (Mapping Symptoms That Make Sense To You)
In this step, you take all the health concerns you have, and you will make lines from one box to another, based on your understanding of how your health concerns are related to one another. This will look different from person-to-person. Your health professional will have a different view of how all this information is related. There is no correct way to do this because it is your personal account. The goal of this exercise is to see how these issues are all inter-related.
As you can see, there are many different variations that you can map out and each one will look different depending on what concerns matter to YOU, the most. The Health Professional will have a different view and that it okay. There may be various views amongst Health Professionals as well. Also, your Health Professional would probably put in more boxes. The point is, is that you see the relationships between how each problem affects you, which will make it easier to see how to address each problem.
Step 3: Figuring Out What Are Your Primary Concerns And What Are Your Related Secondary Concerns
In this step, you are going to find out what are your main concerns are and then what your other concerns are in relation to the main concerns. Your main concerns are largely made up of your diagnoses and the boxes with most lines drawn to it. The boxes with little to no boxes drawn to them, are your other secondary concerns. Once you figure that, you’re going to write them in a list and sub-list format. To better tell the primary and secondary concerns apart from this fictional patient, I highlighted the Main Concerns/Diagnoses.
To reiterate, there is no right or wrong way to fill this out. This process is of YOUR concerns and how they affect YOU. This is not a process of how the Doctor, Nurse, Specialist, etcetera may see your health issues. Only you know what is affecting you.
Step 4: (Problem) Related To (Diagnosis) As Evidenced By (Symptom)
In this step, you are going to create a basic medical phrase that describes your problem. Being able to achieve this, may make it easier for you to properly communicate your problems to your health care provider the next you see them. At this point, you may elaborate with more information that you may have forgotten. You can put it in where you deem it fits best. You will find that you will have to think hard about your daily routine and what is happening in your daily routine; and how it relates to the problem at hand.
You will find that when you structure these phrases, you may not know exactly what to fill in and that is okay. This is especially true of the Main Concern/Diagnosis that has no other boxes under it. If you encounter this, do not worry. You have not done this exercise wrong. It means that you have a concern and do not know what is happening in your body about this concern. This is where you go see your health care provider and discuss this concern with them so that they can give you more information and ideas on how to address this problem.
When you create these medical phrases, make sure they are numbered. This will make the later steps easier to follow.
Step 5: Planning Your Care
In this step, you are going to go down the list that you just created, and you are going to write down what is your goal for each item on the list. You will simply call it, “Goal”. Then after each item, you are going to write down what you are doing to achieve your goal. You are going to title this, “Treatment”. No matter what you write down, be honest and realistic about what you want to achieve. If you want to achieve something that is a large long-term goal, it helps to break it up into smaller and shorter goals in a step-wise pattern. Remember, try not to get too overwhelmed about the overall picture of what you want to achieve, look at the details and focus on the parts that are relevant to you right now. This way, you do not get discouraged easily. Being able to do this step, is a goal planning skill that takes a while to be able to master the process.
Whatever you write, make sure it is SMART: Specific, Measurable, Achievable, Realistic, and Time-Oriented. It MUST be time-oriented because you are focusing on the immediate future and what you can do in the now. Not what you want to do in the far future. It is good to have a goal in mind for the future but, as in all goals; the further in time the goal is, the more likely it is to be altered, adjusted, changed, and what may have started out as a long-term goal for one thing, may be something completely different. This is the nature of short-term goal planning, the endpoint in the future is related but, can and will change; and this is not a failure. It means, it is an unexpected result in moving towards your endpoint and that is why goal planning requires consistent effort, evaluation, adjustment, and re-evaluation. You may find that what you set out to do in the first place is something completely different in the end.
You may also, not know what “Treatment” will be until you discuss this with your Doctor, and that is okay. In that instance, you can leave “Treatment”, blank.
*Remember: This is an opportunity to figure out what your questions are as they relate to a particular concern and to get them answered by your Doctor. A good Doctor will have a good “Plan of Care” for you and will take the time to answer all your questions. You may need to book far ahead for a longer appointment depending on how much you want to discuss. Most importantly, it is not recommended to go on “Doctor Google” to find out the possible causes and things you can do about a particular problem. It is best to use Google for information gathering and leave the diagnosing, treatment, suggestions, and recommendations up to the Doctor. Your Doctor and health care team are there to help you fill in all the blanks you have. You are not alone in this. Going through this exercise is to help your care team better understand YOU from YOUR perspective and not their own medical perspective of you. This way, the things that matter most to you are addressed and you can show what you have actually done in order to try to work towards your goal. This way a visit to the Doctor is not just a repetition of what you have already been doing, but you are discussing new and creative ways of addressing the same ongoing issues. The more engaged and empowered you are, the more your Doctor and Health Care Professionals can help you because you provided them with YOUR direction. Not theirs.
Step 6: Putting It All Together
In this step, we put what we have come up with in steps 4-5 together in a chart format so that it is easy, concise, and your concerns can be seen with a glance.
You are going to align each numbered item from step 4 to its respective item in step 5. You will be writing in linear format the following: “Problem”, “Symptom”, “Goal”, “Treatment/New Treatment”, and “Achieved”.
In separate boxes, you are going to have different headings: “Diagnosis”, “Medication List”, “Follow-Ups/Appt”, & “Labs & Tests To Be Done”.
Doing this document will give you a meaningful way to discuss your concerns with health professionals that are under the pressure of time.
“Your Health Care Snapshot, From Your Perspective”
Now that you have created “Your Health Care Snapshot, From Your Perspective”, the next time you go and see your Doctor, you can bring this handy sheet of paper with you so your Doctor will be able to see what are your health concerns are in a format that is quick to understand. It is easy to see what pieces of information you are missing, what you are doing, what other useful suggestions they can give you, and whether you achieved your goal.
SH’s Adapted Nursing Process Method For Patients: “Your Health Care Snapshot, From Your Perspective”©™ is meant to be a working process in creation of a working document that summarizes a patient’s health at a particular point in time. It is meant as a tool for patient use that engages and empowers patients to not only understand their health but, to promote their health care goals to their health care professional.
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