ROJoson PEP Talk: Patient Mgt Process – Selection of Treatment Process

1. Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.
Patient
Management
Process –
Selection of
Treatment
Process

2. My PEP TALK today
is entitled: Patient
Management
Process – Selection
of Treatment
Process.
Patient
Management
Process –
Selection of
Treatment
Process
Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.

3. I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.
Patient
Management
Process –
Selection of
Treatment
Process
Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.

4. I launched this PEP
TALK on May 15,
2021 with MODULE
on COVID19.
2nd Module
PATIENT
EMPOWERMENT
3rd Module
PATIENT
MANAGEMENT
PROCESS
Patient
Management
Process –
Selection of
Treatment
Process
Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.

5. What I have in mind
in my PEP TALK
which may run for 3
years is to empower
at least 30 persons,
with my family
members and my
patients as a
priority. This is my
key performance
indicator.
I hope you will be in
my group of 30.
Patient
Management
Process –
Selection of
Treatment
Process
Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.

6. This is the Patient
Management Process
Framework.
Patient
Management
Process –
Selection of
Treatment
Process

7. Patient
Management
Process –
Selection of
Treatment
Process
MODULE on
PATIENT
MANAGEMENT
PROCESS
6 Parts
• Overview
• Clinical Diagnostic
Process
• Paraclinical
Diagnostic Process
• Selection of
Treatment Process
• Advice to Patient
Process
• Peculiarities and
Limitations of
Medical Practice

8. Patient
Management
Process –
Selection of
Treatment
Process
MODULE on
PATIENT
MANAGEMENT
PROCESS
6 Parts
• Overview
• Clinical Diagnostic
Process
• Paraclinical
Diagnostic Process
• Selection of
Treatment Process
• Advice to Patient
Process
• Peculiarities and
Limitations of
Medical Practice

9. Patient
Management
Process –
Selection of
Treatment
Process
My PEP TALK today
will focus on this
part of the Patient
Management
Process – Selection
of Treatment
Process.

10. Patient
Management
Process –
Selection of
Treatment
Process
The take-off point for selection of treatment
process is the pretreatment diagnosis.

11. 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.

12. 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.

13. 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.

14. Patient
Management
Process –
Selection of
Treatment
Process
The physician tabulates, compares, and analyzes the options and the BRCA
data like this:
Procedures Benefit (goal of
treatment)
Risk Cost Availability
Option1
Option2
Option3

15. Patient
Management
Process –
Selection of
Treatment
Process
SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
ILLUSTRATION 1
Which is the most cost-effective treatment? OPTION 1
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1 > 3 acceptable 4000 available
Option3 least survival rate acceptable 3000 available

16. Patient
Management
Process –
Selection of
Treatment
Process
SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
ILLUSTRATION 2
Which is the most cost-effective treatment? OPTION 1
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 survR1 =survR2 lesser 5000 available
Option2 survR2 =survR1 more 5000 available

17. Patient
Management
Process –
Selection of
Treatment
Process
SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
ILLUSTRATION 3
Which is the most cost-effective treatment? OPTION 2
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 as effective as 2 acceptable 8000 available
Option2 as effective as 1 acceptable 4000 available

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

19. 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.

20. 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.

21. 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.

22. Patient
Management
Process –
Selection of
Treatment
Process
With this step, one
whole cycle of
patient
management
inclusive of involved
processes is
completed by the
physician with full
participation from
the patient.

23. Patient
Management
Process –
Selection of
Treatment
Process
I will end this PEP
TALK at this point -
end of selection of
treatment processes
and end of health
restoration and
maintenance
processes after
treatment.

24. Patient
Management
Process –
Selection of
Treatment
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
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.

25. Patient
Management
Process –
Selection of
Treatment
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
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.

26. Patient
Management
Process –
Selection of
Treatment
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
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.

27. Patient
Management
Process –
Selection of
Treatment
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
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.

28. Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.
Patient
Management
Process –
Selection of
Treatment
Process

29. Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.
Patient
Management
Process –
Selection of
Treatment
Process
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription
• Expensive
Prescription
• Unnecessary
Operations
• Generic Drugs

30. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

31. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

32. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

33. Patient
Management
Process –
Selection of
Treatment
Process
Unnecessary Prescriptions of Medicines
Strictly speaking, not all medical consultations
should end up with a prescription for medicines.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

34. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

35. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

36. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

37. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Unnecessary
Prescription

38. Patient
Management
Process –
Selection of
Treatment
Process
Expensive Prescriptions of Medicines
A lot of physicians prescribe medicines without regard
to a patient’s financial ability to procure.
Common issues
related to selection
of treatment
process:
• Expensive
Prescription

39. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Expensive
Prescription

40. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Expensive
Prescription

41. Patient
Management
Process –
Selection of
Treatment
Process
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:
Common issues
related to selection
of treatment
process:
• Unnecessary
Operations

42. Patient
Management
Process –
Selection of
Treatment
Process
Unnecessary Operations
- Beware of unnecessary operations for gallbladder polyps (no need if the
polyp is less than 1cm)
Common issues
related to selection
of treatment
process:
• Unnecessary
Operations

43. Patient
Management
Process –
Selection of
Treatment
Process
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)
Common issues
related to selection
of treatment
process:
• Unnecessary
Operations

44. Patient
Management
Process –
Selection of
Treatment
Process
Unnecessary Operations
- Beware of unnecessary thyroid operations which may not be needed for
small benign thyroid nodule.
Common issues
related to selection
of treatment
process:
• Unnecessary
Operations

45. Patient
Management
Process –
Selection of
Treatment
Process
Question commonly asked: Is it advisable to use generic drugs?
My answer is an outright YES.
Common issues
related to selection
of treatment
process:
• Generic
Drugs

46. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Generic
Drugs

47. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Generic
Drugs

48. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Generic
Drugs

49. Patient
Management
Process –
Selection of
Treatment
Process
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.
Common issues
related to selection
of treatment
process:
• Generic
Drugs

50. Patient
Management
Process –
Selection of
Treatment
Process
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
process:
• Generic
Drugs

51. Patient
Management
Process –
Selection of
Treatment
Process
SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA
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.
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Brand-name
drug
as effective as 2 acceptable 4x
higher
available
Generic drug as effective as 1 acceptable x available
Common issues
related to selection
of treatment
process:
• Generic
Drugs

52. Patient
Management
Process –
Selection of
Treatment
Process
THUS, IT IS ADVISABLE TO USE GENERIC DRUGS
AS THEY ARE MORE COST-EFFECTIVE.
Common issues
related to selection
of treatment
process:
• Generic
Drugs

53. Empowerment
objective - for
laypeople to have
an understanding
of the SELECTION
OF TREATMENT
PROCESS in the
Patient
Management
Process.
Patient
Management
Process –
Selection of
Treatment
Process