1.02 FCM Trans - The Five Star Doctor

1.02 18, June, 2015

Dr. Maribel Cruz | The Five Star Doctor preventive, or rehabilitive – will be dispensed in ways that are complementary, integrated, and continuous

SESSION OBJECTIVES

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 To explain the WHO-DOH Five Star Doctor Concept To describe the professional roles and aptitudes of a five-star doctor CONCEPT OF A FIVE-STAR DOCTOR

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An ideal profile of a doctor possessing a mix of aptitudes to carry out the range of services that health settings must deliver to meet the requirements of relevance, quality, cost effectiveness and equity in health.

DEFINITION OF TERMS Relevance - The degree to which most important problems are tackled * Universal relevance - universal access to health - give help first to those who suffer the most - use local resources  Quality - Use of evidenced-based data & appropriate technology to delivercomprehensive health care to individuals and populations, taking into account their social, cultural, and consumer expectations 

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Cost-effectiveness - Those that have the greatest positive impact on the health of a society while making the best use of its resources

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Equity - Striving toward making high-quality care available to all - People’s needs, rather than social privileges, guide the distribution of opportunities for well being

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ROLES OF A FIVE-STAR DOCTOR Health Care Provider Communicator/ Educator Researcher/ Lifelong Learner Manager/ Administrator Community Leader/ Social Mobilizer

1. Health Care Provider  Takes into account the TOTAL (physical, mental, & social) needs of the patient  Ensures that full range of treatment – curative, Transcribers: Agra, Cueto, Pinon, Sy, Verin

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Ensures that treatment is of highest quality Considers the patient as an integral part of a family and community  Ability to cultivate a good doctor & patient relationship considering the various ethical principles  Able to cultivate good-doctor colleague & allied professions in order to give the best care to his patients  Skills of Health Care Provider Communication skills History-taking Physical examination Clinical & Diagnostic Reasoning Prescription Writing Doctor-Patient Relationship Assessing families Preparing health care plan & health promotion 2. Communicator/ Educator  Doctors of tomorrow must be excellent communicators in order to persuade individuals, families, and communities in their change to adopt healthy lifestyle and become partners in the health effort.  Able to promote healthy lifestyle by emphatic explanation, empowering individuals & groups to enhance and protect their health.  Skills of a Health Educator  Establish rapport with people  Assess the patient’s beliefs & perception about the illness  Actively involve the patient & family in the decision making process  Use language understood by the patient and his family  Facilitate learning through a variety of methods  Enlist the reinforcement of social support  Evaluate change & give feedback  Active Listening Skills a. Attending - Paying attention to the need of our patients to be understood and cared for emotionally - Involves the use of our bodies to communicate the nonverbal message that ―I’m listening to you and I understand where you are coming from‖ - L.O.V.E.R.S. Leaning forward Open stance Voice of Compassion Eye contact

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FAMILY & COMMUNITY MEDICINE

Dr. Cynthia Nacpil | Health, Disease and Normality Relaxed position Sitting at an angle

b. Bracketing - Temporarily set aside our own feelings, thoughts, and judgments - Make space in our hearts and minds for what the patient is really saying c.

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Leading c.1. Indirect Lead - Opening invitations made by the doctorcounselor for the patient to talk about anything he desires/ wishes - Allows patient to go wherever he chooses, with the encouragement of the doctorcounselor -Appropriate question: What would you like to talk about?‖ What can I do for you?‖ - Do not say: What is your problem?‖ This may come off as too threatening - Use forms of words or phrases: Yes, Go on, And then, Uh-hmm‖ E E

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c.2. Direct Lead - The doctor –counselor makes a judgment call as to where the patient should go and asks the patient to go to that direction - Picking up from what the patient has already brought out into the open. Do not introduce new material - non-directive‖ ex. tell me what bothered you when you saw his dead face Guidelines in making judgment as to lead conversation:  note wherever the feeling is greatest or most intense  pay attention to what the patient has set aside

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d. Reflecting content, feeling and experience - The patient who is emotionally burdened is unable to see himself or his situation clearly - Acting as a mirror to reflect the patient and his situation so that the patient can see himself and his situation more clearly and thus take the most appropriate action to change his situation. - Takes the verbal content of what the patient says by paraphrasing it so as to make it Transcribers: Agra, Cueto, Pinon, Sy, Verin

clearer d.1. Reflecting content  Paraphrasing – gets the essential content of the patient’s message and restates it in a more summarized and organized manner.  Perception check - in interrogative form, reorients the doctor if the he was mistaken, gives the patient the chance to reexplain himself in a clearer manner d.2. Reflecting feeling - Doctor-counselor articulates the feelings of the patient by making an observation ex. “You seem to be quite anxious about your sore throat” d.3. Reflecting Experience - Reflecting the non-verbal cues to the patient ex. “I noticed that your lips quivered when I talked about blood”

e. Focusing The doctor-counselor stirs the conversation into the topic that is relevant to the patient’s concern ex. "This point seems worth looking at more closely." "You said something earlier that I want you to go back to.” f.

Probing - The doctor-counselor asks questions that can elicit more information from the patient. - Should be open-ended and NOT answerable by a yes or no. Ex. “Looking back, what would you do differently now, if anything?” “Compare this to what others have done.” “What did your supervisor say / do?” “What was the outcome?” “Why did you do that?” 3. Researcher/ Lifelong Learner  Research is important in the delivery of health care services even in the primary care level  Chooses which technology to apply ethically & cost effectively while enhancing the care that he or she provides  Uses evidence-based medicine in the practice of the profession  Has the responsibility to add the body of knowledge so that more effective level  Able to critically appraise literature to be able

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FAMILY & COMMUNITY MEDICINE

Dr. Cynthia Nacpil | Health, Disease and Normality to make good decisions in terms of treatment and management

4. Manager / Administrator  Manages a clinic, hospital, community health programs & projects  Can work harmoniously with individuals & organizations within & outside the health care system, in order to meet his/her patient’s & community needs  Coordinate health care of patients & their families with other physicians & agencies through referral, networking, & linkages  Skills of Manager/Administrator  The referral system  Community organizing & management  Resource generation & financial management  Health policies & legislation

Transcribers: Agra, Cueto, Pinon, Sy, Verin

5. Community Leader/ Social Mobilizer  Does not simply treat individuals who seek help but will also take a positive interest in community health activities, which will benefit large numbers of people  Who, after having won the trust of the people among whom he/she works with, can reconcile individual & community requirements and initiate action in behalf of the community  The core of primary health care is people empowerment  A physician has the task to change specific behavior of patients & their families or members of the community to achieve a goal  A physician plays a catalyst in accelerating & sustaining program implementation through active and collective participation of GOs and NGOs in the community

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