VLE: Person- Centred Care & Relationship Models

Sarah & James

Definitions are key to being great at VLE!

• What is person-centred care?– An approach to interaction with patients and

implementation of care that:

“…is responsive to individual, personal preferences, needs and values, and assures that patient values guide all clinical decisions.”

– Find one that works for you and stick with it.

Which ethical principles and values underpin PCC?

• Autonomy– The capacity to be one's own person, to live one's life according to

reasons and motives that are taken as one's own and free from manipulation.

• Respect– Due regard for the feelings, wishes or rights of others

• Consequentialism– End justifies the means (EBM –proven to lead to better health

outcomes, hurray!)• Dignity

– Maintaining the patients self-esteem, privacy and freedom from pain.• Deontology (Beneficence)

– The duty of a doctor to provide care and compassion

Key elements of person-centred care (6)

Patient Involvement• Persons needs and

preferences (AS THEY DEFINE THEM) come first and above those identified by clinician

• Recognise the patients strengths in self-care and management of conditions

• Public involvement in the design and implementation of services

• SHARED DECISION MAKING

Relationship building• Actually seeing and getting

to know the patient as a ‘person’

• All interactions underpinned by values of compassion, dignity and respect.

• SHARED DECISION MAKING

Models of Doctor-Patient Relationships

• Jenny, 24, presents to her GP with increased frequency and pain on micturition. She recognised the symptoms after having a UTI a few months ago and wants to be prescribed Trimethoprim as this cleared her infection quickly the last time.

Shared?Patient-led?Doctor-led?

Models of Doctor-Patient Relationships

• George, 62, is brought into the ED after experiencing acute onset chest pain at the gym following a brutal spin class. Dr Young is the on-call registrar and asks George a series of systematic, closed questions about the incident. George nods and shakes his head a lot before being told he has stable angina, and is sent home with a new bottle of pills.

Shared? Patient-led? Doctor-led?

Models of Doctor-Patient Relationships

• Mrs Chowdry, 72, suffers from CKD and is now in stage 5 renal failure. She attends an appointment with her nephrologist, Dr Watson, to discuss management options. Dr Watson talks her through the process of dialysis and the transplant list. Mrs Chowdry notes that she would not like the clutter of having to administer peritoneal dialysis in her own house. Together they agree that Mrs Chowdry will attend a programme of haemodialysis at her local hospital.

Shared? Patient-led? Doctor-led?

Calgary-Cambridge model

• This is how we put it all into practice!• 2 functions:

– Building relationships– Providing a structure

• 5 components:1) Commencing consultation2) Gathering information3) Physical examination4) Explanation and planning5) Closing consultation

• But what skills do each comprise…??

Questions??

(We know ethics and principles can be a bit vague, find some definitions that work for you – throw in an example

if you can – that’s where the exam marks come from!)