RLO: Principles of Family Medicine

4. Person-centred Care

In family medicine, we focus on the patient's needs, values, preferences and desired health outcomes in the clinical evaluation and management plan. Patients are informed, empowered and involved in clinical decision making. Person-centred care emphasizes the need to respect patient's beliefs and values, the importance of communication and providing support to the patient.³ Person-centred care improves the patient's satisfaction and self-management.⁴

The acronym 'ICE' for ideas, concerns, and expectations about diagnosis and treatment is a communication model for a person-centred approach in family medicine. Exploring patient's ideas, concerns and expectations provides insight into the reasons for a clinic consultation, giving clues to establish the right diagnosis, influences the process of shared decision making. It leads to better medical communication and improves patient-doctor partnership in the patient's care.

Watch the video to see how Dr. Fatimah explores James's 'ICE'.

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Transcript

Dr. Fatimah: James, your blood pressure reading today is 160/90 mmHg. What do you think of your blood pressure control? (IDEA)

James: Doctor, sometimes my blood pressure goes up but sometimes it goes down. I do not have any symptoms when the blood pressure was high. I think it is alright.

Dr. Fatimah: I see. I have prescribed you amlodipine since the last visit, to add on with the existing perindopril medication. How is the medication so far?

James: To be honest doctor, I didn't take the amlodipine that you have prescribed.

Dr. Fatimah: May I know what is the reason? anything that you particularly worried about? (CONCERN)

James: Ya, I'm worried that too many medications might affect my kidney function. I have seen my uncle, who has been taking so many medications, ended up having kidney failure and requires dialysis.

Dr. Fatimah: I understand your reason and concern for not taking the amlodipine. Your blood pressure reading is high today. We would aim to bring down your blood pressure to be less than 140/90 mmHg to prevent the complications of hypertension such as heart disease, stroke or kidney failure. I understand that you are particularly worried about the side effects of medication on your kidneys. There are multiple reasons that could cause kidney failure and uncontrolled high blood pressure is one of the reasons as well. In fact, antihypertensive medications will bring down the blood pressure and protect your kidneys.

James: I see. Now I understand the reasons to take the medication for my blood pressure control.

Dr. Fatimah: What do you think might be the best way that we could tackle your blood pressure issue? (EXPECTATION)

James: I think I can try to take both amlodipine and perindopril regularly. Is it possible that you check my kidney function regularly?

Dr. Fatimah: Sure! We will perform annual blood and urine tests for your kidney function. I'm sure you can control your blood pressure better after this.