Optimising Personal Value

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The need to focus on the value of the individual patient is increasingly receiving attention. Maureen Bisognano, the charismatic former Director of the Institute of Healthcare Improvement, advocated that we move from ‘what’s the matter medicine’ to ‘what matters to you medicine.’

Professor Al Mulley of Dartmouth University and his colleagues coined the term ‘the silent misdiagnosis’ to describe the common situation in which clinicians have accurately diagnosed a disease but have failed to identify the patient’s preferences. They argue that not only do decisions need to be based on the best current evidence but also that decision-making needs to be sensitive to the preferences of individual patients. When seeking to explain the causes of unwarranted variation, Jack Wennberg highlighted that patients’ preferences were often either not elicited or, if they were, their preferences would be ignored. Furthermore evidence based medicine, initially criticised as ‘cookbook’ medicine has from its earliest days emphasised the importance of personalisation.

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patient’s predicaments, rights, and preferences in making clinical decisions about their care.”

Source: Sackett, D. L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S. (1996)

Evidence based medicine: what it is and what it isn’t. BMJ 312;81

Module 7 Micromodules and Topics

  • Micromodule 7.1 – Understanding Personal Value
  • Micromodule 7.2 – Understanding Barriers, and Approaches to, Optimising Personal Value

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