Essential Values-Based Practice: Clinical Stories Linking Science with People

231 Pages·2012·3.306 MB·English

by  K. W. M. Fulford, Ed Peile, Heidi Carroll

Essential Values-Based
Practice
Clinical Stories linking Science with People

Essential Values-Based
Practice
Clinical Stories linking Science with People
K.W.M. (Bill) Fulford
EmeritusProfessorofPhilosophyandMentalHealth,UniversityofWarwickMedicalSchool,UK
Ed Peile
EmeritusProfessorofMedicalEducation,UniversityofWarwickMedicalSchool,UK
Heidi Carroll
GeneralPractitioner,Aberdeenshire,UK
cambridge university press
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Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationwhichisinaccordwith
acceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesaredrawnfromactualcases,everyefforthas
beenmadetodisguisetheidentitiesoftheindividualsinvolved.Nevertheless,theauthors,editorsandpublisherscanmakeno
warrantiesthattheinformationcontainedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantly
changingthroughresearchandregulation.Theauthors,editorsandpublishersthereforedisclaimallliabilityfordirector
consequentialdamagesresultingfromtheuseofmaterialcontainedinthisbook.Readersarestronglyadvisedtopaycareful
attentiontoinformationprovidedbythemanufacturerofanydrugsorequipmentthattheyplantouse.
Review quotes
As a primary care physician who has spent over 25 “Essentialsisanoutstandingexampleofclearwriting,
years in the USA caring for patients, teaching, and essential references and useful clinical reasoning.”
developing curricula, I am continually searching for Professor Giovanni Stanghellini, Co-Chair of the World Psychiatric
strategiestohelppatients,medicalstudents,andphysi- Association (WPA) Section on the Humanities and Chair of the
cians get “unstuck” and get on with the business of Association of European Psychiatrists (AEP) Section on Philosophy
healing and health. Essential Values-based Practice: andPsychiatry.
Linking Science with People provides coherent tools
“Constantly reinforce(s) the reality of value issues in
and frameworks thatIam eagerto useas a provider,
everyday practice.” Dr Roger Neighbour, Past President Royal
a teacher, and a carer. The values-based practice
CollegeofGeneralPractitionersandauthorofTheInnerConsultation
framework outlined in the premise, the process, and
andTheInnerApprentice.
the point offers information that can be used to sup-
port self-awareness, reflective practice, and explora-
tion of values – the provider’s and the patient’s.
Alicia D.H. Monroe, MD Vice Dean Educational Affairs, University of
SouthFloridaCollegeofMedicine.
v

Contents
Foreword pageix
Acknowledgments xi
Aboldclaimtostartthisbook xii
Prologue:linkingsciencewithpeople xiii
Part 1. Values, individuals and an Part 3. Relationships in values-based
overview of values-based practice practice
IntroductiontoPart1 1 IntroductiontoPart3 97
1. “It’smyback,Doctor!”(episode1):valuesand 8. “Best”inbreastcancer:clinicianvaluesand
clinicaldecision-making 3 person-centeredcare 99
Values-basedpracticeelement5:person-values-centered
2. “It’smyback,Doctor!”(episode2):applying
practice
thetoolsalreadyintheclinicaltoolboxfor
workingwithvaluestoindividuals 11 9. Risksinsafeguardingchildren:teamvalues
aswellasskills 115
3. Anoutlineofvalues-basedpractice:itspoint,
Values-basedpracticeelement6:theextended
premiseandten-partprocess 24
multidisciplinaryteam
Part 2. The clinical skills for
Part 4. Science and values-based
values-based practice
practice
IntroductiontoPart2 37
IntroductiontoPart4 131
4. Recoveryinschizophrenia:avalueswake-up
10. Thereluctanthypertensive:thinkevidence,
call 39
thinkvaluestoo! 133
Values-basedpracticeelement1:awarenessofvalues
Values-basedpracticeelement7:theTwo-feet
5. Teenageacne:wideningourvalues Principle
horizons 55
11. Unexplainableabdominalpain:thinkvalues,
Values-basedpracticeelement2:reasoningaboutvalues
thinkevidencetoo! 143
6. Asmokingenigma:getting(andnotgetting) Values-basedpracticeelement8:theSqueaky-wheel
theknowledge 65 Principle
Values-basedpracticeelement3:knowledgeaboutvalues
12. Electivefertility:thinkhigh-tech,think
7. Diabeticcontrolandcontrollers:nothing evidenceandvalues! 151
withoutcommunication 83 Values-basedpracticeelement9:theScience-driven
Values-basedpracticeelement4:communicationskills Principle
vii
Contents
Part 5. Bringing it all together
Postscript:thesmallchangeofcare 201
IntroductiontoPart5 163 Aboldclaimtoendthisbook 204
AppendixA: Values-basedpracticesummaryand
13. Agood(enough)death:dissensusin definitionsofkeyterms 205
end-of-lifecare 165 AppendixB: Values-basedpracticeteaching
Values-basedpracticeelement10:partnershipin framework 208
decision-making Index 211
14. “It’smyback,Doctor!”(episode3):buildinga
sharedframeworkforvalues-based
practice 185
viii
Foreword
Julia Samuel
FounderPatronandTrusteeoftheChildBereavementCharity
Thisistrulybrilliantbook.Inthetwenty-first-century reading this book is given both a map and a way of
medicalenvironment,drivenbythedualpullsofhigh thinkingwhichprotectsagainstthesealltoofrequent
costs and cost effectiveness. Patients can get sub- irrevocable mistakes, and ensures the family receives
merged in technology, protocols, and paperwork, to thebestpossiblecareatsuchadifficulttime.
the extent they lose their humanity and experience Thecoherencewithwhichtheauthorsunpickcom-
themselvesasacasenumber,notaperson.Thisbook plexandusuallyintangible,aswellasexplicit,situations
highlights the challenge medical teams, having a ple- is extraordinary. They keep the same themes running
thora of scientific knowledge, encounter every day throughoutthetext,linkingandreinforcingthemwith
when faced with the uniquely human problems of eachcasestudy,givingtheirargumentsalotofweight.
each individual patient. Its guidance puts the heart Iwasfascinatedbythedifferentscenarios,whichech-
backintomedicine. oed some of my own experiences with patients and
My experience with families whose children have madethetextcomealiveandeasytoread.Theyinten-
died has taught me that, even when medicine fails tionally didn’t describe the “nightmare” examples
as tragically as when a child dies, how the family is where bad practice, bad stories, and bad outcomes
respondedtoatthetimehasalife-longimpactonthat come together, recognizing that it is the more subtle
family,forgoodorill.Everyconversation,everydeci- everydaysituationthatisthekeylearninginthisbook,
sion,everygestureisburnedintheirmemoryforlife. becauseitisfromthemthatindividualpatientsreceive
Oftentheunforgiveableerrorsaremoretodowiththe genuineperson-centeredcare.
lack of attuned care than with medicine: not enough Thisbookisahugelywelcomeclarioncallbackto
proper reflection on the needs of this family, careless the essential values in medicine, that keys into the
assumptionsmade,insensitivecommunication,which natural motivation of most doctors, to reach out to
might be appropriate for another family, but is the individual patient and make a difference. It is a
receivedwithfurybythisparticularfamily,toomuch veryimpressivebook,andIcouldn’tbemoredelighted
haste to get “it over with.” Any medical professional toendorsetheimportanceandvalueofitsmessages.
ix