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Presentation held at the 51st ICCA Congress which took place in San Juan, Puerto Rico from 20 - 24 October 2012. For more information on ICCA please visit www.iccaworld.com.
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The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of truth Knowledge society and the interpretation of truth
Wieland Kiess, MD
Hospital for Children and AdolescentsDepartment of Women and Child HealthUniversity of Leipzig, Leipzig, Germany
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Internet, medicine and the patient
� Health
� Internet, data banks
- chances and opportunties
- dangers and deficits
� Knowledge and the knowledge society
� Experts and evidence-based medicine
� Service versus enterpreneurship
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Internet, medicine and the patient
1. General availability of information
2. Wide array of information sources
3. Era of advertising and manipulation
4. Lack of quality check and control
5. Expert opinion vs. truth vs. evidence
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Health - definitions (WHO)
1. Absence of disease
2. Presence of well being
Our expectations, our wishes, our dreams
Hokusai Katsushika (1760-1849) Elf blinde buddhistische Mönche untersuchen einen Elefanten, können sich aber nicht auf eine Definition einigen. Japanische Illustration einer alten Fabel buddhistische Mönche untersuchen einen Elefanten, können sich aber nicht auf eine Definition einigen. Japanische Illustration einer alten Fabel
Individual health definitionsIndividual health definitions
´I am afraid´,
you have cancer´
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Internet, data banks
1. chances and opportunties
2. dangers and deficits
Use and abuse
Availability and ability
Relation with societal, cultural, education, and
economic conditions
Hello, does anyone hear me?Hello, does anyone hear me?(MMW –19.01.2006)(MMW –19.01.2006)
The six elements of a structured doctor patient conversation:
• Establish relation• Listen to problem• Allow for emotions• Explore details • Discuss actions to be taken• Summarize
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Knowledge and the knowledge society
Why donWhy don’’t we know it all?t we know it all?
Many “Leaks” from research & practiceMany “Leaks” from research & practice
Aware Accept Target Doable Recall Agree Done
ValidResearch
If 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
From Evidence to Practice From Evidence to Practice US Paediatricians’ SurveyUS Paediatricians’ Survey
0
20
40
60
80
100
Aware Agree Adopt Adhere
Hepatitis BPertussis
Pathman, Medical Care, 1996: 873-9.
Many “Leaks” from research & practiceMany “Leaks” from research & practice
Aware Accept Target Doable Recall Agree Done
ValidResearch
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Experts and evidence-based medicine
Medication Errors
Is bed rest ever helpful?Is bed rest ever helpful?A systematic review of trials*A systematic review of trials*
*Allen, Glasziou, Del Mar. Lancet, 1999
� 10 trials of bed rest after spinal puncture � no change in headache with bed rest
� UK neurology units - 80% still recommend bed rest after lumbar puncture (Serpell M, BMJ 1998)
� …evidence of harm available for 17 years preceding...
The rise and rise of patient powerThe rise and rise of patient power
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
� Service versus enterpreneurship
1. Florence Nightingale
2. Hospital companies
3. For profit vs. non-profit hospitals
4. The physician as an enterpreneur
5. The physician as an altruistic caring person
Quality management in the health care system
Patient
Doctor
Apotheken
Hospitals
IndustriesNurse
Insurances
Politician
Presse
Administrator
Society
The rise and rise of patient power -The rise and rise of patient power -
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
Summary
and
Conclusions
Questions are (missed) opportunitiesQuestions are (missed) opportunities
� Most of our questions are NEVER answered
� When answered, the information is likely to be neither the best nor up-to-date
The rise and rise of patient power -The rise and rise of patient power -
Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth
´He who does not believe in ´He who does not believe in miracles is not a realistic person´miracles is not a realistic person´ (Ben Gurion)(Ben Gurion)
Thank you for your attention !