Empowerment

objective - for
Patient laypeople to have
Management an understanding of
Process – the PECULIARITIES
Peculiarities AND LIMITATIONS
and OF MEDICAL
Limitations of PRACTICE that affect
Medical Patient
Practice Management
Process.
 Empowerment
I have a Patient
objective - for Empowerment
Patient laypeople to have Program in which I
Management an understanding of like to empower the
Process – the PECULIARITIES lay people or
Peculiarities AND LIMITATIONS patients to take
and OF MEDICAL control in the
Limitations of management of
PRACTICE that affect their health.
Medical Patient
Practice Management
Process.
 I launched this PEP
Empowerment TALK on May 15,
objective - for 2021 with MODULE
Patient laypeople to have on COVID19.
Management an understanding of
Process – 2nd Module
the PECULIARITIES PATIENT
Peculiarities AND LIMITATIONS EMPOWERMENT
and OF MEDICAL
Limitations of PRACTICE that affect
3rd Module
Medical PATIENT
Patient MANAGEMENT
Practice Management PROCESS
Process.
 Empowerment What I have in mind
objective - for in my PEP TALK
Patient laypeople to have
which may run for 3
Management years is to empower
an understanding of at least 30 persons,
Process – the PECULIARITIES with my family
Peculiarities AND LIMITATIONS members and my
and OF MEDICAL patients as a
Limitations of PRACTICE that affect priority. This is my
Medical Patient
key performance
Practice indicator.
Management I hope you will be in
Process. my group of 30.
 Empowerment My PEP TALK today
objective - for is entitled: Patient
Patient laypeople to have Management
Management an understanding of Process –
Process – the PECULIARITIES Peculiarities and
Peculiarities AND LIMITATIONS
Limitations of
and Medical Practice.
OF MEDICAL
Limitations of PRACTICE that affect
Medical Patient
Practice Management
Process.
Patient
Management
Process –
Peculiarities and This is the Patient
Management Process
Limitations of Framework.
Medical Practice
 MODULE on
PATIENT
Patient
MANAGEMENT
Management PROCESS
Process – 6 Parts
Peculiarities and • Overview
• Clinical Diagnostic
Limitations of Process
Medical Practice • Paraclinical
Diagnostic Process
• Selection of
Treatment Process
• Advice to Patient
Process
• Peculiarities and
Limitations of
Medical Practice
 The Patient Management
Patient Process is essentially problem-
Management solving and decision-making of
Process – a patient’s health concern. It
Peculiarities and is a complex process in that
Limitations of one, it involves a lot of steps
Medical Practice (diagnosis and treatment and
advice) and in each step, there
is a series of actions which are
carried out in order to achieve
a particular result or goal, the
reason for calling the Patient
Management as a Process.
 Second, although there are
Patient guidelines in the use of
processes in achieving a
Management
particular goal, implementing
Process –
them do not always ensure
Peculiarities and attainment of goals. The main
Limitations of reason for this is that there
Medical Practice are peculiarities and
limitations in the science of
medicine and its practice that
pose challenges and
hindrances in accomplishing
the goals one hundred
percent.
Patient All physicians are fully aware
Management of these peculiarities and
Process – limitations and have adjusted
Peculiarities and to them and have factored
them in their management of
Limitations of
their patients.
Medical Practice
Patient All patients or laypeople
Management should also be made aware of
Process – at least, if not fully
Peculiarities and understand, these
peculiarities and limitations so
Limitations of
that they can adjust to them
Medical Practice
and factor them in their
management of their health
concerns and issues.
Patient This awareness will also
Management facilitate their participation in
Process – the problem-solving and
Peculiarities and decision-making with their
physicians, in the sense that
Limitations of
both parties are aligned in
Medical Practice
understanding of the
peculiarities and limitations of
the science of medicine and its
practice.
Patient By the way, I am using the
Management word “peculiarities” in the
Process – title to mean eccentricity, that
Peculiarities and is, deviation from the
established pattern or norm or
Limitations of
from the usual. I may also use
Medical Practice
it to mean idiosyncrasy, that
is, unusual feature or
behavior.
Patient I am using the word
Management “limitations” in the title to
Process – mean the greatest amount,
Peculiarities and extent, or degree of
something that is possible or
Limitations of
allowed BUT not able to
Medical Practice
achieve the full capability.
Patient As we discuss this topic,
Management have in mind the Patient
Process – Management Process and at
Peculiarities and the same time, have in mind
Limitations of the peculiarities and
Medical Practice limitations of the science and
practice of medicine and see
how the latter affects the
former.
Patient  MAXIMS, RULES AND GUIDES IN THE
Management MANAGEMENT OF A PATIENT
Process – (in Consideration of Peculiarities and Limitations
Peculiarities and of Medical Practice)
Limitations of
Medical Practice
Patient  MAXIMS, RULES AND GUIDES IN THE
Management MANAGEMENT OF A PATIENT
Process – (in Consideration of Peculiarities and Limitations
Peculiarities and of Medical Practice)
Limitations of
Medical Practice BASIC MAXIMS
1. Medicine is an inexact science.
2. Medicine is an art of probability.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
BASIC MAXIMS
Limitations of
Medical Practice 3. Ideal goals or fighting targets in patient
management by physicians:
Resolution of the health problem in such as a
way that the patient does not end up dead; with
no complications and no disability as much as
possible; and in such a manner the patient is
satisfied.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and BASIC MAXIMS
Limitations of 4. Because of limitations of medicine, the ideal
Medical Practice goals or fighting targets in patient management
cannot be achieved all the time. What is most
important is that physicians exert their best,
rational, honest and humane or compassionate
efforts in managing patients to the satisfaction
or delight of the patients even in the absence of
complete resolution of the health problem.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and BASIC MAXIMS
Limitations of
Medical Practice
5. Best effort by physicians at all times:
“Cure sometimes,
relieve often,
comfort always.”
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of Medical
Process – Practice)

Peculiarities and BASIC MAXIMS

Limitations of 6. Nothing is absolute in medicine.
Medical Practice 6.1 There are exceptions to the rules.
6.2 Anything is possible.
6.3 There are more than one way of doing things in
medicine.
6.4 There is no such thing as absolutely certain
diagnosis, whether it be clinical, paraclinical,
histopathologic, or postmortem diagnosis.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and BASIC MAXIMS
Limitations of
Medical Practice
7. The only routine in medicine is a rational
decision-making in the management of a patient
with a health problem.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and BASIC MAXIMS
Limitations of 7.1 Rational decision-making weighs the
Medical Practice probability of being successful in the
achievement of the goals in the management of
a patient.
7.2 Rational decision-making relies more on
general rules than on the exceptions.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and BASIC MAXIMS
Limitations of 7.3 Rational decision-making banks on the more
Medical Practice common rather than on the least common or
rare events.
7.4 Rational decision-making uses processes
rather than gut-feel.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and BASIC MAXIMS
Limitations of 7.5 A rational decision-making may not always
Medical Practice be correct. As long as the decision-making is
rational, it is acceptable. A rational decision-
making is more often correct than wrong
compared to an irrational decision-making.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management (in Consideration of Peculiarities and Limitations of Medical
Process – Practice)
Peculiarities and THE DIAGNOSTIC PROCESS AND THE DIAGNOSIS
Limitations of 1. The diagnostic process must be rational for it to be
Medical Practice acceptable.
2. A diagnosis that is based on a rational process is
not always correct. However, a diagnosis is more
often correct than wrong if it is rationally arrived at.
3. A diagnosis is almost always an educated guess.
  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
Patient PATIENT
Management (in Consideration of Peculiarities and Limitations of
Process – Medical Practice)

Peculiarities and INTERVIEW AS A DIAGNOSTIC TOOL

Limitations of 1. Identify the chief concern or main problem of the
Medical Practice patient. Once identified, use it as the steering wheel in
the diagnostic investigation of the patient.
1.1 Inquire on the circumstances associated with the chief
concern.
1.2 Inquire on symptoms. Symptoms are those
manifestations perceived by the patient.
1.3 Get clues from the “circumstances and symptoms” to
be used in the diagnosis of the patient.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
INTERVIEW AS A DIAGNOSTIC TOOL
Limitations of
Medical Practice 2. Be effective. Be complete. Be efficient. Be
relevant.
3. Know how to get cues from data.
to interpret data.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
INTERVIEW AS A DIAGNOSTIC TOOL
Limitations of
Medical Practice 4. Know which data to pursue.
to put in the background
to use in the diagnosis
not to use in the diagnosis
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PHYSICAL EXAM AS A DIAGNOSTIC TOOL
Limitations of
1. Use the identified chief concern or main problem of the
Medical Practice patient as a guide on what to examine.
1.1 Look for signs. Signs are those manifestations
perceived by the physicians.
1.2 Get clues from the signs to be used in the
diagnosis of the patient.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PHYSICAL EXAMINATION AS A DIAGNOSTIC TOOL
Limitations of
Medical Practice 2. Be effective. Be complete. Be efficient. Be
relevant.
3. Know how to get cues from data.
to interpret data.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PHYSICAL EXAMINATION AS A DIAGNOSTIC TOOL
Limitations of
Medical Practice 4. Know which data to pursue.
to put in the background
to use in the diagnosis
not to use in the diagnosis
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
INTERVIEW AND PHYSICAL EXAMINATION
Limitations of
Medical Practice 1. Interview and physical examination can be
done in any order as dictated by the
circumstances.
2. Interview and physical examination can be
done simultaneously.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
INTERVIEW AND PHYSICAL EXAMINATION
Limitations of
Medical Practice 3. The goal of interview and physical
examination is diagnosis.
4. Correlate data from interview and physical
examination to come out with a rational clinical
diagnosis.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
INTERVIEW AND PHYSICAL EXAMINATION
Limitations of
Medical Practice 5. If there is a question on which data to put
more reliance on, choose the “sign” data over
“symptom” data. Remember, however, that for
the “sign” data to be reliable, they must be
accurate.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
CLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 1. A clinical diagnosis is one that is derived from
the interview and physical examination, or put in
another way, it is one that is derived from the
symptoms and signs.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
CLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 2. Essentially, two processes are used in coming
out with a clinical diagnosis. These two
processes are pattern recognition and
prevalence.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
CLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 3. Pattern recognition means the realization that
the patient’s presentation conforms to a
previously learned picture or pattern of disease.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
CLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 4. Prevalence means the 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  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
CLINICAL DIAGNOSTIC PROCESS
Limitations of
5. Elemental steps in making a diagnosis:
Medical Practice
5.1 Identify which organ or tissue or system is involved.
5.2 Then, identify the disease in general terms, such as
inflammation, infection, tumor, trauma, endocrine, etc.
5.3 Then, try to be more specific in identifying the disease,
if possible, such as malignant neoplasm, abscess, etc.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
CLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 6. Knowing the nomenclature of diseases
facilitates diagnostic labeling.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PARACLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 1. After the clinical diagnosis, the next step to do
is to determine whether a paraclinical diagnostic
procedure is needed or not. A paraclinical
diagnostic procedure is a diagnostic procedure
that is done after the clinical diagnosis is arrived
at and its objective is to make the diagnosis
more definite.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PARACLINICAL DIAGNOSTIC PROCESS
Limitations of
2. To decide whether a paraclinical diagnostic
Medical Practice procedure is needed or not, a physician should
consider the following factors:
2.1 How certain he is with the clinical diagnosis.
2.2 Whether a more definite diagnosis is needed or
not for some reasons or another.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PARACLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 3. Once a decision is made that a paraclinical
diagnostic procedure is needed, the next step is
to choose the most cost-effective procedure for
the patient by doing the following:
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PARACLINICAL DIAGNOSTIC PROCESS
Limitations of
The
3. physician
Once a decisiontabulates, compares,
is made that and
a paraclinical analyzes the options and the
diagnostic
Medical Practice procedure is needed, the next step is to choose the most
BRCA data like this:
cost-effective
Procedures procedure
Benefitfor(goal
the patient
– to by considering
Risk the
Cost Availability
various factors (tabulate,
be more compare, andon
definite analyze):
the diagnosis)
Option1        
Option2        
Option3        
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
PARACLINICAL DIAGNOSTIC PROCESS
Limitations of
Medical Practice 4. After the paraclinical diagnostic procedure has
been done, the next step is to interpret the
result. The result of the paraclinical diagnostic
procedure must be correlated with the signs and
symptoms of the patient to come out with a
pretreatment diagnosis.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SELECTION OF TREATMENT PROCESS
Limitations of
Medical Practice 1. Selection of treatment procedure is based
primarily on the pretreatment diagnosis.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SELECTION OF TREATMENT PROCESS
Limitations of
Medical Practice 2. Select the most cost-effective treatment for
the patient by doing the following:
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SELECTION OF TREATMENT PROCESS
Limitations of
2. Select
The the mosttabulates,
physician cost-effective treatmentand
compares, for the patient the options and the
analyzes
Medical Practice after considering the various factors (tabulate compare,
BRCA data like this:
and analyze):
Procedures Benefit (goal of Risk Cost Availability
treatment)
Option1        
Option2        
Option3        
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SELECTION OF TREATMENT PROCESS
Limitations of
Medical Practice 3. The final decision on the type of treatment to
institute will rest on the patient.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
Limitations of SPECIAL ISSUES RELATED TO
Medical Practice LIMITATIONS OF PHYSICIANS
• Knowing when and to whom to
refer
• Second opinion
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
KNOWING WHEN AND TO WHOM TO REFER
Limitations of
Medical Practice There will always be patients whose health
problems will be beyond a physician’s existing
competencies.
Such patients may have a very unusual health
problem whose diagnosis is extremely difficult.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
KNOWING WHEN AND TO WHOM TO REFER
Limitations of
Medical Practice Such patients may have usual health problems
but whose treatment is beyond a physician’s
existing competencies (example - a primary care
physician who has not been trained to do a
surgical operation).
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
KNOWING WHEN AND TO WHOM TO REFER
Limitations of
Medical Practice True to all physicians, regardless of amount of
training and experience, there will always be
patients whose health problems are beyond
their present existing competencies.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
KNOWING WHEN AND TO WHOM TO REFER
Limitations of
Medical Practice When to refer?
All physicians must know their limitations. Only
they themselves can determine their own
limitations. They must realize their limitations
so that they do not cause undue harm to their
patients and so that they know when to refer to
colleagues.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
KNOWING WHEN AND TO WHOM TO REFER
Limitations of
Medical Practice When to refer?
Refer means asking for help from and conferring
with colleagues. Referring a patient to a
colleague may mean totally transferring the care
of a patient to him or continuing to manage the
patient with his help. A proper communication
either oral or written is in order.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
KNOWING WHEN AND TO WHOM TO REFER
Limitations of
To whom to refer?
Medical Practice
Referral must be made to somebody
who may or can solve the patient’s health problem
rationally, effectively, efficiently, and humanely, and
who has a good track record of handling the kind of
problem on hand.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice “Second opinion” means seeking another
opinion on patient management from another
physician or health care professional.
Second opinion can be sought by both physicians
and patients.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Physicians seek second opinion from medical colleagues
Medical Practice when they realize their limitations – when they are
beating their heads against the wall in trying to know the
true diagnosis and how best to treat the patient.
Physicians can informally communicate with their medical
colleagues from whom they want to seek an opinion or
they can formally advise patients (give a referral letter) to
seek a second opinion from another physician.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice Patients on their own free will seek second
opinion from another or other physicians for at
least two valid reasons:
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice Patients –
• they are not fully satisfied with the
explanations of the first physician (either no
or incomplete or unclear explanations)
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice Patients –
 they want to validate the explanations and
recommendations of the first physician
(because they are hesitant to accept the
recommendations and they hope there will be
different recommendations from the next
physician congruent to their personal desire).
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice Note: Seeking another physician is not always
equivalent to seeking second opinion. Seeking
another physician may have other reasons aside
from second opinion.
Patients may be primarily “shopping” for
physicians who can offer the best or affordable
medical expenses.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice They may be looking for other physicians whom
they can communicate better and with whom
they can have better rapport, trust and
confidence compared to the first physician.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice They may be looking for other physicians
because of convenience of continued medical
care such as physical proximity of the clinics of
the physicians and their affiliated hospitals.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice All patients have the right to seek second
opinion for whatever reasons they may have.
Nobody will, can and should question their
reasons.
Basis: all patients have the right to make their
own choices and be the primary decision-maker
with regards to their health concerns and issues.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice They have the right to seek medical opinions
from another physician after the first and to as
many physicians they want.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Medical Practice The foremost objective indication for second
opinion should be if the first physician is not
explaining or not advising well using rational
patient management processes in diagnosis and
treatment.  If he does, there may be no need for
a second opinion. If he does not, there is a need
for a second opinion.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
It is not wise for patients to seek second opinion all
Medical Practice the time.  Only as needed or as indicated. There are
benefits as well as potential harms in second
opinions. A benefit is facilitation of proper problem-
solving and decision-making. Potential harms could
be confusion because of so many differing opinions;
getting wrong advice; and doing wrong problem-
solving and decision-making.
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
Simply going by “plurality” of opinions is not as strong,
Medical Practice not to say valid, a reason in seeking a second opinion
compared to the foremost indication mentioned above. 
Going by “plurality” of opinions is no assurance that the
recommendation is correct and should be adopted.  One
may end up choosing the most popular medical opinion
rather than the most rational one backed up by good
processes. 
Patient  MAXIMS, RULES AND GUIDES IN THE MANAGEMENT OF A
PATIENT
Management
(in Consideration of Peculiarities and Limitations of
Process – Medical Practice)
Peculiarities and
SECOND OPINION
Limitations of
So, if one seeks second opinion, beware of the danger of
Medical Practice seeking from physicians who do not use the Patient
Management Process to explain and advise. The advice
given may be just based on the current trend and fad and
not based on in-depth analysis of the patient’s actual
medical conditions, inherent psychological make-up of
patient and not based also on concrete medical data,
information and evidences.
 I will end this PEP
Empowerment TALK at this point.
objective - for
Patient laypeople to have
Management an understanding of
Process – the PECULIARITIES
Peculiarities AND LIMITATIONS
and OF MEDICAL
Limitations of PRACTICE that affect
Medical Patient
Practice Management
Process.
 Empowerment
Take away in this
objective - for PEP TALK that are
Patient laypeople to have
Management related to Patient
an understanding of Empowerment:
Process – the PECULIARITIES
Peculiarities AND LIMITATIONS
and OF MEDICAL
Limitations of PRACTICE that affect
Medical Patient
Practice Management
Process.
 Take away in this
PEP TALK that are
related to Patient
Empowerment:
Empowerment Understand the
objective - for Peculiarities and
Patient laypeople to have Limitations of
Management an understanding of Medical Practice as
Process – the PECULIARITIES
they affect the
Peculiarities Patient
AND LIMITATIONS Management
and OF MEDICAL Process so that you
Limitations of PRACTICE that affect will not be
Medical Patient frustrated with the
Practice Management outcomes.
Process.
 Take away in this
PEP TALK that are
related to Patient
Empowerment:
Empowerment
objective - for Be ready to ask
Patient laypeople to have questions if the
Management an understanding of physician is not
Process – the PECULIARITIES advising you
Peculiarities AND LIMITATIONS properly and
and OF MEDICAL
adequately on the
Limitations of peculiarities and
PRACTICE that affect limitations.
Medical Patient
Practice Management
Process.
 Take away in this
PEP TALK that are
related to Patient
Empowerment:
Empowerment
Participate actively
objective - for
Patient and fully in the
laypeople to have problem-solving and
Management an understanding of
Process – decision-making of
the PECULIARITIES your health
Peculiarities AND LIMITATIONS concerns with your
and OF MEDICAL physicians factoring
Limitations of PRACTICE that affect in the peculiarities
Medical Patient and limitations of
Practice Management medical science and
Process. practice.
 Take away in this
PEP TALK that are
related to Patient
Empowerment:
Empowerment Master the peculiarities
objective - for and limitations of medical
Patient laypeople to have science and practice as
Management an understanding ofthey may help you in
Process – the PECULIARITIES some way in deciding for
Peculiarities AND LIMITATIONS
your own health concern
and in considerations of the
OF MEDICAL oddities. This is one other
Limitations of PRACTICE that affect
Medical way of gaining greater
Patient control in your health
Practice Management concerns and issues.
Process.
 Empowerment
objective - for
Patient laypeople to have
Management an understanding of
Process – the PECULIARITIES
Peculiarities AND LIMITATIONS
and OF MEDICAL
Limitations of PRACTICE that affect
Medical Patient
Practice Management
Process.