Empowerment

objective - for
laypeople to have
Patient an understanding
Management of the Patient
Process – An Management
Overview Process – how a
patient is being
and should be
managed.
 Empowerment I have a Patient
objective - for Empowerment
Program in which I
laypeople to have
like to empower the
Patient an understanding lay people or
Management of the Patient patients to take
Process – An Management control in the
Process – how a management of
Overview
patient is being their health.
and should be
managed.
 I launched this PEP
Empowerment TALK on May 15,
2021 with MODULE
objective - for on COVID19.
laypeople to have
an understanding 2nd Module
Patient PATIENT
Management of the Patient
EMPOWERMENT
Process – An Management
Overview Process – how a 3rd Module
patient is being PATIENT
and should be MANAGEMENT
PROCESS
managed.
 MODULE on
PATIENT
MANAGEMENT
PROCESS
Empowerment
objective - for 6 Parts
laypeople to have • Overview
• Clinical Diagnostic
Patient an understanding Process
Management of the Patient • Paraclinical
Diagnostic Process
Process – An Management • Selection of
Overview Process – how a Treatment Process
patient is being • Advice to Patient
Process
and should be • Peculiarities and
managed. Limitations of
Medical Practice
 What I have in mind
Empowerment in my PEP TALK
objective - for which may run for 3
laypeople to have years is to empower
an understanding at least 30 persons,
Patient with my family
Management of the Patient
members and my
Process – An Management patients as a
Overview Process – how a priority. That is my
patient is being key performance
and should be indicator.
managed. I hope you will be in
my group of 30.
 My PEP TALK today
Empowerment is entitled: Patient
objective - for Management
laypeople to have Process, an
Patient an understanding Overview.
Management of the Patient
Process – An Management
Overview Process – how a
patient is being
and should be
managed.
 I will give you one
Patient second to have a quick
Management glance at the framework
Process – An of Patient Management
Process so as to prime
Overview you on my talk but I will
not discuss it yet as I
want first to do a little
introduction and give a
backgrounder to the
framework.
 A patient in the medical context is
someone who has a health
Patient
concern.
Management
Process – An
Overview That health concern has to go
through the processes of
problem-solving and decision-
making to know what it is first (or
diagnosis) and then to know what
to do to resolve it (or treatment).
This in essence is the gist of
“Patient Management Process.”
 As early as 1989, I formally
formulated a Patient
Patient
Management Process framework
Management or algorithm (PMP) which I have
Process – An been using since then in my
Overview private practice and teaching in
health care institutions such as
medical schools and hospitals.
Modesty aside, I find my PMP
simple and practical to follow and
to teach both the health care
professionals and the laypeople.
 Although this framework was
originally made with the health
Patient
care professionals (physicians and
Management medical students) in mind,
Process – An
Overview
I honestly think it can be used to
teach and should be taught to
laypeople so that there will be
alignment of expectations from
both parties, meaning the
physicians and patients.
 In understanding the Patient
Management Process, laypeople
Patient
will know how to participate in
Management the problem-solving and decision-
Process – An making of their health concerns
Overview with their physicians.

First and foremost, they will

know what to ask the healthcare
professionals before they make
decisions on their health
concerns.
 Second, they can evaluate
whether the health care
Patient
professionals are using proper
Management and rational processes or not
Process – An (such as just using the matching-
Overview type questions and answers) in
their recommendations.

This could serve as a ground to

seek opinion from another
healthcare professional, the so-
called second opinion.
 In understanding the Patient
Management Process, even in the
Patient
absence of health care
Management professionals, laypeople may
Process – An know what to do with their
Overview health problems, at least the
processes in problem-solving and
decision-making.

With this competence, they can

gain greater control on what to
do with their health concerns and
issues.
 Do all the above benefits of
knowing Patient Management
Patient
Process remind you of the
Management concept of Patient
Process – An Empowerment?
Overview
Pagpapalakas ng Pasyente and
the K4 –
Kaalaman,
Kakayanan,
Karapatan and
Kapangyarihan?
 A word about using processes
versus using matching-type
Patient
questions and answers in
Management problem-solving and decision-
Process – An making.
Overview
 In matching-type questions and
answers in solving problems, you
Patient
have premises then
Management straightforward responses.
Process – An For example, if you have this symptom
Overview or set of symptoms and signs, then the
diagnosis is this or that.
If you need a paraclinical diagnostic
procedure for a particular diagnosis,
then the procedure should be this or
that.
Likewise, in treatment, it will be this or
that for a particular type of diagnosis.
 The problem-solving and
decision-making processes for
Patient
health concern are more complex
Management than performing matching-type
Process – An questions and answers as we
Overview shall see later on.

By the way and suffice for me to

say at this moment,
a process is defined as a series of
actions which are carried out in
order to achieve a particular
result.
 Here again is the diagram of my
Patient Management Process
Patient
framework or algorithm.
Management
Process – An
Overview For today, I will just present the
gist in each step and the involved
processes.

I will do the detailed discussion in

the next sessions.
Patient
Management
Process – An
Overview

A patient consults a physician.

The goal of the physician is resolution of the health problem in such a way
that the patient does not end up dead; as much as possible with no
complications and no disability; in such a manner that the patient is
satisfied. These are the universal goals of all physicians. These are also
rightfully the expectations of the patients.
Patient
Management
Process – An
Overview

A patient consults a physician.

What are the four basic categories of functions or tasks expected of a
physician?
Patient
Management
Process – An
Overview

What are the four basic categories of functions or tasks expected of a physician?
 Rapport
 Diagnosis – Advice
 Treatment – Advice
 Advice
The general quality standards that can be used for these 4 tasks are
rational, effective, efficient and humane.
Patient
Management
Process – An
Overview

After establishing RAPPORT with the patient,

the physician starts accomplishing the task of DIAGNOSIS.
Patient
Management
Process – An
Overview

The physician does interview to get symptom data and does physical
examination to get sign data after which he does the clinical diagnostic
processes to come out with the clinical diagnosis.
Patient
Management
Process – An
Overview
The clinical diagnostic processes consist of pattern recognition and
prevalence.
Pattern recognition process means realization that the patient’s
presentation conforms to a previously learned picture or pattern of
disease.
Prevalence process means choice of a diagnosis is based on the frequency
of occurrence of the disease in a certain locality, in a certain age and sex
group, and in the affected organ and system.
Patient
Management
Process – An
Overview CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA – ILLUSTRATION 1
Knowing the common manifestations of 5 different diseases as follows:
                                Disease A - abcd (manifestations)
                                Disease B - fghi
                                Disease C - klmn
                                Disease D - pqrs
                                Disease E - uvwx
Given a patient manifesting with pqrs, your diagnosis is Disease D. 
What is the process used? PATTERN RECOGNITION
Patient
Management
Process – An
Overview
CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA – ILLUSTRATION 2
Knowing the common manifestations of 3 different diseases and relative
frequency of each as follows:
                                Disease A -  abcd (manifestations)           Least common
                                Disease B -  abcd
                                Disease C -  abcd                                      Most common
Given a patient manifesting with abcd, your diagnosis is Disease C. 
What is/are processes used? Pattern Recognition but mainly PREVALENCE
Patient
Management
Process – An
Overview

Cleft lip?

Cleft lip and

palate?

Dx and process used?

Patient
Management
Process – An
Overview

Cleft lip?

Cleft lip and

palate?

PROCESS USED in Dx: PATTERN RECOGNITION

Patient
Management
Process – An
Overview

Dx and process used?

Patient
Management
Process – An
Overview
Dx: HYPERTHYROIDISM

PROCESS USED in Dx: PATTERN RECOGNITION

Patient
Management
Process – An
Overview
Patient has cough, cold, fever and tiredness.
What is your most probable diagnosis and process
used?
• COVID19 (SARS-COV-2 virus)?
• FLU (influenza virus)?
• Common colds (rhinovirus)?
Patient
Management
Process – An
Overview
Patient has cough, cold, fever and tiredness.
What is your most probable diagnosis and process
used?
• COVID19 (SARS-COV-2 virus) *** during time of
pandemic / epidemic [PREVALENCE PROCESS]
• FLU (influenza virus)
• Common colds (rhinovirus)
Patient
Management
Process – An
Overview Patient has cough, cold, fever and tiredness.
What is your most probable diagnosis and process
used?
• COVID19 (SARS-COV-2 virus)
• FLU (influenza virus) *** during time of
pandemic / epidemic /outbreak [PREVALENCE
PROCESS]
• Common colds (rhinovirus)
Patient
Management
Process – An
Overview

The outputs of the clinical diagnostic processes are primary clinical

diagnosis (most probable or most likely) and secondary clinical diagnosis
(alternate or second most probable or less likely).
Patient
Management
Process – An
Overview

After the clinical diagnostic processes and formulation of clinical diagnosis,

the physician gives advice to the patient, meaning he tells and explains the
findings and diagnosis and entertains and answers questions from the
patient.
Patient After the formulation of the clinical diagnosis,
Management the physician decides whether he needs a
Process – An paraclinical diagnostic procedure or not.
Overview “Paraclinical” here means done after the
clinical diagnosis.

The foremost indication for a paraclinical

diagnostic procedure can be stated this way:

if you are not certain on the primary clinical

diagnosis and you need to be certain or be
more certain before treatment, then go for a
paraclinical diagnostic procedure.
Patient To decide on indication of the paraclinical
Management diagnostic procedure,
Process – An
Overview
the physician uses two processes –

degree of certainty on the primary clinical

diagnosis and
comparison of the treatment plans for the
primary and secondary clinical diagnoses.
Patient PARACLINICAL DIAGNOSTIC PROCESS –
Management INDICATION - PROCESSING OF DATA –
ILLUSTRATION
Process – An
Overview
Certainty of Primary Clinical Diagnosis
60% (needed)
----------------------------------------------------------------------
-------- 99% (not needed)

Treatment Plans for Primary and Secondary

Diagnoses
Different (needed)
----------------------------------------------------------------------
Patient PARACLINICAL DIAGNOSTIC PROCESS –
Management INDICATION - PROCESSING OF DATA –
ILLUSTRATION 2
Process – An
  Certainty Plan of
Overview Treatment
Primary clinical 98% Surgical
diagnosis
Secondary 1-2% Nonsurgical
clinical diagnosis

Is a paraclinical diagnostic procedure

needed? NO unless there is a strong reason
to do so (exception to the rule)
Patient After analyzing the indication for a paraclinical
Management diagnostic procedure,
Process – An the physician advises the patient on this by
Overview explaining the processes that he uses and the
outcome of his analysis.

He recommends; waits and answers queries

from the patient; allows the patient to decide;
and forges a shared agreement.
Patient If there is a need for a paraclinical diagnostic
Management procedure, the physician uses the B-R-C-A
Process – An processes.
Overview B – stands for benefit; R – risk; C – cost; A –
Availability.
Patient The physician gives or lists the various options
Management of paraclinical diagnostic procedures and then
Process – An gives data on the BRCA.
Overview With the data given, the patient is asked what
he prefers.
Procedures Benefit Risk Cost Availability
(goal – to
be more
definite on
the
diagnosis)

Option1        
Option2        
Option3        
Patient
Management
Process – An PARACLINICAL DIAGNOSTIC PROCESS – SELECTION - PROCESSING OF
Overview DATA – ILLUSTRATION
Procedures Benefit (goal – to be Risk Cost (PhP) Availability
more definite on the
diagnosis)
Option1 accuracy 99% acceptable 4000 available
Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available
Which will be chosen? OPTION 1 if patient can afford. If not, OPTION 2 can be
chosen because it has a 90% accuracy which is high enough.
Patient So, the advice given by the physician at this
Management point consist of explaining the processes of
Process – An selection (BRCA) to choose the most cost-
Overview effective paraclinical diagnostic procedure and
to the desire of the patient.

He can recommend. He waits and answers

queries from the patient; allows the patient to
decide; and forges a shared agreement.
Patient Assuming that a paraclinical diagnostic
Management procedure is done.
Process – An The physician has to interpret the results of the
Overview paraclinical diagnostic procedure.
To do this, he uses two processes – assessment
of the accuracy of the report and correlation
with the clinical findings.
Then, he advises the patient on his
interpretation and proceeds to discussion of
treatment.
Patient Before the selection of a treatment
Management procedure,
Process – An the physician decides on the pretreatment
Overview diagnosis which is obtained from repeated
assessment of the accuracy of the clinical
diagnosis and paraclinical diagnosis and
correlation of the two.
He advises the patient on the pretreatment
diagnosis.
He then spells out the objectives or aims of
treatment.
Patient He then gives or lists the various options of
Management treatment; uses the B-R-C-A processes in the
Process – An selection; and gives data on the BRCA.
Overview With the data given, the patient is asked what
he prefers.

Treatment Benefit Risk Cost Availability

(goal of
treatment)
Option1        
Option2        
Option3        
Patient
Management
Process – An SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
Overview ILLUSTRATION
Procedures Benefit (goal of Risk Cost (PhP) Availability
treatment)
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1  > 3 acceptable 6000 available
Option3 least survival rate acceptable 3000 available

Which should be chosen? OPTION 1

Patient So, the advice given by the physician at
Management
this point consist of explaining the
Process – An
processes of selection (BRCA) to choose
Overview
the most cost-effective treatment
procedure and to the desire of the
patient.
He can recommend. He waits and
answers queries from the patient;
allows the patient to decide; and forges
a shared agreement.
Patient
Management
Process – An
Overview

Once a shared agreement is arrived at, the

treatment is executed.
Just before, during and right after treatment,
the physician advises patient on preparation,
outcome, things to monitor, etc.
Patient
Management
Process – An
Overview

After treatment, the physician advises patient

on health restoration and maintenance.
With this step, one whole cycle of patient
management inclusive of involved processes
is completed by the physician with full
participation from the patient.
 That in brief,
Patient is an overview of the ROJoson
Management Patient Management Process
framework or algorithm.
Process – An
Overview
There are still a lot of nitty-gritty
things to discuss or things to
expound, but these will be done
in subsequent sessions.
 Take away in this PEP TALK that
are related to Patient
Patient
Empowerment:
Management
Process – An
Overview
 Take away in this PEP TALK that
are related to Patient
Patient
Empowerment:
Management
Process – An Foremost, the ROJoson Patient
Overview Management Process framework
or algorithm clearly spells out the
universal goals of treatment; the 4
basic categories of functions to be
performed by the physician
(Rapport, Diagnosis, Treatment,
and Advice); and the involved
processes that have to be done
within each function.
 Take away in this PEP TALK that
are related to Patient
Patient
Empowerment:
Management
Process – An The problem-solving and decision-
Overview making processes for all health
concerns do not simply utilize
performing matching-type
questions and answers. They are
more complex. They involve a
series of actions which are carried
out in order to achieve a particular
objective or result.
 Take away in this PEP TALK that
are related to Patient
Patient
Empowerment:
Management
Process – An In understanding the Patient
Overview Management Process being done by
physicians, laypeople will know how to
participate in the problem-solving and
decision-making of their health concerns
with their physicians.
With problem-based and self-directed
learning, in the absence of health care
professionals, they may even know what
to do with their health problems within
their capacity and capability.
 Take away in this PEP TALK that
are related to Patient
Patient
Empowerment:
Management
Process – An Understanding the Patient
Overview Management Process will
redound to Patient
Empowerment:
Pagpapalakas ng Pasyente
with its K4 – Kaalaman,
Kakayanan, Karapatan and
Kapangyarihan.
 Empowerment
objective - for
laypeople to have
Patient an understanding
Management of the Patient
Process – An Management
Overview Process – how a
patient is being
and should be
managed.