Empowerment

objective - for
laypeople to have
Patient
an understanding
Management
of the SELECTION
Process –
OF TREATMENT
Selection of
PROCESS in the
Treatment
Patient
Process
Management
Process.
 Empowerment My PEP TALK today
objective - for is entitled: Patient
laypeople to have Management
Patient Process – Selection
an understanding
Management of Treatment
of the SELECTION
Process – Process.
OF TREATMENT
Selection of
PROCESS in the
Treatment
Patient
Process
Management
Process.
 Empowerment I have a Patient
objective - for Empowerment
laypeople to have Program in which I
Patient
an understanding like to empower the
Management lay people or
of the SELECTION
Process – patients to take
OF TREATMENT
Selection of control in the
PROCESS in the management of
Treatment
Patient their health.
Process
Management
Process.
 I launched this PEP
Empowerment TALK on May 15,
objective - for 2021 with MODULE
laypeople to have on COVID19.
Patient
an understanding 2nd Module
Management
of the SELECTION PATIENT
Process –
OF TREATMENT EMPOWERMENT
Selection of
PROCESS in the
Treatment 3rd Module
Patient PATIENT
Process
Management MANAGEMENT
Process. PROCESS
 Empowerment What I have in mind
in my PEP TALK
objective - for
which may run for 3
laypeople to have years is to empower
Patient
an understanding at least 30 persons,
Management
of the SELECTION with my family
Process –
OF TREATMENT members and my
Selection of patients as a
PROCESS in the
Treatment priority. This is my
Patient
Process key performance
Management indicator.
Process. I hope you will be in
my group of 30.
 This is the Patient
Patient Management Process
Management Framework.
Process –
Selection of
Treatment
Process
 MODULE on
Patient PATIENT
MANAGEMENT
Management PROCESS
Process – 6 Parts
Selection of • Overview
• Clinical Diagnostic
Treatment Process
Process • Paraclinical
Diagnostic Process
• Selection of
Treatment Process
• Advice to Patient
Process
• Peculiarities and
Limitations of
Medical Practice
 MODULE on
PATIENT
Patient MANAGEMENT
Management PROCESS
Process – 6 Parts
• Overview
Selection of • Clinical Diagnostic
Treatment Process
Process • Paraclinical
Diagnostic Process
• Selection of
Treatment Process
• Advice to Patient
Process
• Peculiarities and
Limitations of
Medical Practice
Patient My PEP TALK today
Management will focus on this
Process – part of the Patient
Selection of Management
Treatment Process – Selection
of Treatment
Process
Process.
Patient
Management
Process –
Selection of
Treatment
Process

The take-off point for selection of treatment

process is the pretreatment diagnosis.
Patient
Management
Process –
Selection of
Treatment
Process

Before the selection of a treatment procedure, the physician decides on

the pretreatment diagnosis which is obtained from repeated assessment of
the accuracy of the clinical diagnosis and paraclinical diagnosis and
correlation of the two.
Patient
Management
Process –
Selection of
Treatment
Process

He advises the patient on the pretreatment

diagnosis.
He then spells out the objectives or aims of
treatment.
Patient
Management
Process –
Selection of
Treatment
Process

In the selection of most cost-effective treatment procedure, the physician

uses the B-R-C-A processes. B – stands for benefit; R – risk; C – cost; A –
Availability. The physician gives or lists the various options of treatment
procedures and then gives data on the BRCA. With the data given, the
patient is asked what he prefers.
Patient
Management
Process –
Selection of The physician tabulates, compares, and analyzes the options and the BRCA
Treatment data like this:
Process Procedures Benefit (goal of Risk Cost Availability
treatment)
Option1        
Option2        
Option3        
Patient
Management
Process –
Selection of SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
Treatment ILLUSTRATION 1 
Process
Procedures Benefit (goal of Risk Cost (PhP) Availability
treatment)
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1  > 3 acceptable 4000 available
Option3 least survival rate acceptable 3000 available

Which is the most cost-effective treatment? OPTION 1

Patient
Management
Process –
Selection of SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
Treatment ILLUSTRATION 2 
Process
Procedures Benefit (goal of Risk Cost (PhP) Availability
treatment)
Option1 survR1 =survR2 lesser 5000       available
Option2 survR2 =survR1 more 5000 available

Which is the most cost-effective treatment? OPTION 1

Patient
Management
Process –
Selection of SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
Treatment ILLUSTRATION 3
Process
Procedures Benefit (goal of Risk Cost (PhP) Availability
treatment)
Option1 as effective as 2 acceptable 8000       available
Option2 as effective as 1 acceptable 4000 available

Which is the most cost-effective treatment? OPTION 2

Patient
Management
Process –
Selection of SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
Treatment ILLUSTRATION 4 
Process
Procedures Benefit (goal of Risk Cost (PhP) Availability
treatment)
Option1 most effective acceptable 2000       available
Option2 effectivity <1 >3 acceptable 3000 available
Option3 least effective acceptable 4000 available

Which is the most cost-effective treatment? OPTION 1

Patient
Management
Process –
Selection of
Treatment
Process

At this point, the physician should be explaining the processes of selection

(BRCA) to choose 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 –
Selection of
Treatment
Process Once a shared agreement is arrived at, an informed consent or informed
refusal is formalized.
If there is an informed refusal, the treatment is not executed.
If there is an informed consent, the treatment is executed.
Just before, during and right after the treatment procedure, the physician
advises patient on the preparation, outcome, things to monitor, etc.
Patient
Management
Process –
Selection of
Treatment
Process

After treatment, the physician advises patient on health restoration and

maintenance processes – the do’s and don’ts; recovery period; resumption
of major life activities; restoring and maintaining healthy lifestyle; etc.
 With this step, one
Patient whole cycle of
Management patient
Process – management
Selection of inclusive of involved
Treatment processes is
Process completed by the
physician with full
participation from
the patient.
Patient I will end this PEP
TALK at this point -
Management
end of selection of
Process –
treatment processes
Selection of and end of health
Treatment restoration and
Process maintenance
processes after
treatment.
Patient Take away in this
Management PEP TALK that are
Process – related to Patient
Selection of Empowerment:
Treatment
Process

At this point of the PEP TALK, understand the Patient Management Process
framework in terms of what the physicians are doing and should be doing
in the selection of treatment processes and health restoration and
maintenance processes after treatment.
Patient Take away in this
Management PEP TALK that are
Process – related to Patient
Selection of Empowerment:
Treatment
Process

Be ready to ask questions based on the requirements of the processes,

particularly when a physician is not using the processes or is not clear and
full in explanation.
Patient Take away in this
Management PEP TALK that are
Process – related to Patient
Selection of Empowerment:
Treatment
Process

Participate actively and fully in the problem-solving and decision-making

of your health concerns with your physicians in coming out with the most
cost-effective treatment procedure and to your desire.
Patient Take away in this
Management PEP TALK that are
Process – related to Patient
Selection of Empowerment:
Treatment
Process

Master the selection of treatment processes as they may help you in some
way in deciding for your own health concern - on how to choose the most
cost-effective one and to your desire, particularly when there is no health
care professional around to assist you. This is one other way of gaining
greater control in your health concerns and issues.
 Empowerment
objective - for
laypeople to have
Patient
an understanding
Management
of the SELECTION
Process –
OF TREATMENT
Selection of
PROCESS in the
Treatment
Patient
Process
Management
Process.
 Empowerment Common issues
objective - for related to selection
laypeople to have of treatment
Patient process:
an understanding
Management
of the SELECTION
Process – • Unnecessary
OF TREATMENT Prescription
Selection of
PROCESS in the • Expensive
Treatment
Patient Prescription
Process
Management • Unnecessary
Process. Operations
• Generic Drugs
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines
In the Philippines, it is a common expectation of patients that at the end of
a medical consultation, there should be a prescription for medicines.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines
This mindset is primarily instilled or influenced by the practice of a lot of
physicians who would routinely prescribe at least one medicine even when
it is strictly speaking not needed.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines

The physicians would usually like to shorten the medical consultation by

prescribing a medicine rather than spending time to explain the diagnosis,
basis of diagnosis, treatment options, including why a medicine is strictly
not needed. The physician’s writing the prescription is a signal to the patient on the
end of the medical consultation.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines

Strictly speaking, not all medical consultations

should end up with a prescription for medicines.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines

In fact, there are a lot of medical consultations that end up with clinical
diagnoses that need advice only and do not need a prescription.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines

If only the physicians will explain fully and clearly the clinical diagnosis
that strictly speaking do not need medicine for treatment, then there will
be less unnecessary prescriptions; less side effects from the medicines
prescribed; and less expense on the part of the patients.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines

There are a lot of medical consultations that end up with clinical diagnoses
that only need supportive management – like rest, change in lifestyle,
hydration, nutrition, exercise and hygiene. No medicines are actually
needed.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Prescription
Unnecessary Prescriptions of Medicines

Examples in this era of COVID19 pandemic, a lot of asymptomatic and mild

COVID19 patients are taking a lot of unneeded medicines like antibiotics,
vitamins, immune boosters, etc. The World Health Organization has
declared they are not needed.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Expensive
Process
Prescription
Expensive Prescriptions of Medicines
A lot of physicians prescribe medicines without regard
to a patient’s financial ability to procure.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Expensive
Process
Prescription
Expensive Prescriptions of Medicines
They don’t use the selection of treatment process.
They may be influenced by the trends and fads and/or by the
pharmaceutical companies.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Expensive
Process
Prescription
Expensive Prescriptions of Medicines
Thus, it is important to discuss with your physician on the medicine
prescribed; if there are other alternates which are as effective but cheaper.
Do not hesitate to ask if the medicine has a generic counterpart.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Operations
Unnecessary Operations
There are a lot of unnecessary operations going on.
Here are some examples that I am aware of and part of my advocacies:
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Operations
Unnecessary Operations
- Beware of unnecessary operations for gallbladder polyps (no need if the
polyp is less than 1cm)
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Operations
Unnecessary Operations
- Beware of unnecessary breast biopsy for suspicious lesions reported by
radiologists (these may turn out to be fibrocystic changes)
- Beware of unnecessary breast operation (macrocysts of the breast can
just be treated with needle aspiration with no need for excision operation)
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Unnecessary
Process
Operations
Unnecessary Operations
- Beware of unnecessary thyroid operations which may not be needed for
small benign thyroid nodule.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs
Question commonly asked: Is it advisable to use generic drugs?

My answer is an outright YES.

Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs
What are generic drugs?
A generic drug is a medication created to be the same as an already
marketed brand-name drug in dosage form, safety, strength, route of
administration, quality, performance characteristics, and intended use. 
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs
What are generic drugs?
A generic medicine works in the same way and provides the same clinical
benefit as the brand-name medicine. 
In other words, you can take a generic medicine as an equal substitute for
its brand-name counterpart.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs
How come the generic drugs cost less than the brand-name medicines?
Generic drugs tend to cost less than their brand-name counterparts
because generic drug applicants do not have to repeat animal and clinical
(human) studies that were required of the brand-name medicines to
demonstrate safety and effectiveness.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs
Are generic drugs at par with the brand-name medicines?
YES, because they contain the same active ingredients as the brand-name
medicines. Also, the Food and Drug Administration (FDA) has already
looked at the quality of medicines before they are approved to be
marketed in the country. 
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs
Are generic drugs at par with the brand-name medicines?
Thus, generics should have the same quality as the branded ones. If the
generic drugs are fake and not approved by the FDA, then they may not be
safe and effective. Thus, it is important to get medicines only from FDA-
approved pharmacies.
 Common issues
related to selection
of treatment
Patient process:
Management
Process – • Generic
Selection of Drugs
Treatment SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA
Procedures Benefit (goal of Risk Cost (PhP) Availability
Process treatment)
Brand-name as effective as 2 acceptable 4x available
drug higher    
Generic drug as effective as 1 acceptable x available
If we take a look at the selection of treatment process, it is but rational to
choose the generic drugs because they are as effective as the brand-name
drugs; same risks; and cost less.
Patient Common issues
Management related to selection
of treatment
Process –
process:
Selection of
Treatment • Generic
Process
Drugs

THUS, IT IS ADVISABLE TO USE GENERIC DRUGS

AS THEY ARE MORE COST-EFFECTIVE.
 Empowerment
objective - for
laypeople to have
Patient
an understanding
Management
of the SELECTION
Process –
OF TREATMENT
Selection of
PROCESS in the
Treatment
Patient
Process
Management
Process.