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PATIENT-CENTERED CARE MANAGEMENT
How ROJoson Got Involved in Patient-centered Care Management
Patient-centered care management is the practice of caring for patients (and their relatives) in ways that are meaningful and valuable to the individual patient. It includes listening to, informing and involving patients in their care.
The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”
In patient-centered care, an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.
Patient-centered care - care based on patient's needs and preferences.
ROJoson started his journey on Patient-centered Care Management (PCCM) in 1982 when he formally started his private practice in general surgery. PCCM was not formally and intensely taught when he was a medical student in UPCM and in surgical residency training in PGH. He would continuously improve his management of patients along the principles of PCCM using problem-based learning and self-directed learning. Circa 1985, he formulated his Management of a Patient Process including its maxims, rules and guides which would promote rational, holistic, professional, compassionate, and cost-effective treatment. [Link: https://rojosonmedicaleducation.wordpress.com/2017/06/13/maxims-rules-and-guides-in-the-management-of-a-patient-rojoson/]
Because of his promotion of the Management of a Patient Process, the surgery residents of PGH gave him a monicker of “Josonics” or “Josonic Disciples.” Here are some quotes on his monicker during his retirement in 2014 from PGH.
“Allow me to thank you, in behalf of the numerous students you have equipped with your “josonics”, I am thanking you with all my heart for everything you have done for us.” – Dr. Anthony Perez (2014)
“I still apply “Josonics” among my students. This mindset has been spread thru batches of residents not just in PGH. The words like “Is it normal or is it abnormal? ” and “Is there a mass”? still echoes vividly in my brain. In the world of fast changing innovations in medical practice, logic keeps me grounded to the basics. Thanks to you Dr. Reynaldo O Joson.” – Dr. Leonardo Ona (2014)
“Thank you Dr Joson for the mentoring. Josonics is a big part of my daily clinical decision making.” – Dr. Sara Padua-Labilles (2014)
“We are your JOSONICS disciples!” – Dr. Alex Lagon Cerrillo (2014)
“I am very happy for you and happy to be a Josonic student. I first encountered the word when I came to PGH. Dr. Catalan asked me once “So you’re a Josonic?” To which I replied yes, yes I am. And I’ve heard the word a lot since then… “– Dr. Hazel Turingan (2014)
“RJ as he is called by his GS1 friends, gave a “josonite” speech regarding his thoughts after retirement. Oh man! An excellent speech. A standing ovation, it was.” – Dr. Lito Legaspi (2014)
“Yes, I believe the words “Josonic”, “ Josonites” were coined in the mid 1990’s: we started using it sometime 1993-1994, you were Chief of GS 1 and you came up with the GS 1 Vision Mission Goals, and I remember that I was GS 1 Senior Resident then Surgical Oncology Fellow around that time…” – Dr. Malou Matsuda (2014)
“The surgical residents used to say the word "Josonic", whenever we would try to dissect a problem to its basic dimensions, and try to come up with effective solutions using a risk-benefit table. To be Josonic meant that one was being a critical thinker, and that one was being rational. I was proud to be called "Josonic" by my colleagues.” – Dr. Malou Matsuda (2004)
ROJoson’s Achievements and Contributions to Society in the Local and National Level
From 1982 to 2019 (37 years), ROJoson was deeply improving, practicing and promoting patient-centered care management. He has done at least the following:
· Practicing the “Management of a Patient Process” on his patients (in his clinic, in the operating room, in the nursing floors, and outside and also in his telemedicine).
· Teaching the “Management of a Patient Process” to medical students and surgical residents he have come into contact with (UPCM, PGH, Ospital ng Maynila Medical Center, Zamboanga City Medical Center, etc.)
· Incorporating the “Management of a Patient Process” in the problem-based medical curricula of the Zamboanga Medical School Foundation / Ateneo de Zamboanga University School of Medicine, Bicol Christian College of Medicine, and Southwestern University College of Medicine.
· Incorporating the “Management of a Patient Process” in the Quality and Safe Management System of Salubris Medical Center in Nueva Vizcaya (2016-2017).
Examples of ROJoson’s Way in Patient-centered Care Management
Minimalist and vigilant watchful waiting approach in managing patients resulting in value-based health services and patient experience
ROJoson is a minimalist physician. As a minimalist physician, he usually does only what is required or essential in the medical management and he does things as simple as possible and still produce good results and quality outcomes.
He relies heavily on physical examination and interview for symptoms for a diagnosis.
He does diagnostic tests only when needed. In case diagnostic tests will be done, he chooses the simplest and cost-effective ones. He uses a benefit, risk, cost and availability comparison of all diagnostic options for the selection. He advises the patients on the selection to get an informed consent, resulting in a shared decision-making (which contributes to patient experience).
For treatment, he chooses the simplest and cost-effective ones. He uses a benefit, risk, cost and availability comparison of all treatment options for the selection. He advises the patients on the selection to get an informed consent, resulting in a shared decision-making (which contributes to patient experience).
This minimalist with vigilant watchful waiting usually results in value-based health care services for patients, meaning appropriate, effective, and safe health care services with good results and quality outcomes at reasonable cost.
This minimalist with vigilant watchful waiting resulting in value-based health care services contributes to patient experience. Patient experience is defined as “The patient’s cumulative evaluation of the journey they have with you, starting when they first need you and based on their clinical and emotional interactions, which are shaped.” With valued-based health care services coupled with my holistic, professional and compassionate care, patient experience can easily be achieved.
ROJoson Medical Clinic – NO Queueing, NO Long Waiting Time for Patients (Started 2015)
Using a system of booked appointment time, ROJoson was able to promote no queueing, no long waiting time for his patients. The patients like his booked appointment time. Some of his students are following suit.
Here are some feedback:
18apr26 - Sir good morning po. This is Michelle Galang-Melendez po, one of your former surgery residents in OMMC. Sir I saw your strategy in preventing long waiting period for patient in your facebook account. I think its very patient friendly and would prevent future legal problem on our part. I would like to ask permission po from you so I could use it, though I would edit some parts po to fit in the province. Sir is it ok if I “copy” it. Thank you po for lending some of your time reading this. (18apr26 Feedback)
18jul19 - Ramon Unchuan Brod, kudos 2u. I think u are the only one who has an appointment system, FMAB & Cebu doctors don't have! And u can wait for hours! I practiced for 30 years in Sweden: 30 minutes is max the patient for the appointment time, otherwise consultation fee is refunded & the patient can continue to wait OR gets a new time the next day! No show patient will be sent a bill for consultation fee! If the patient comes 10 min. LATE the physician will not see him, & will have to pay the CONSULTATION FEE!
Violeta Chua Reyes Saludo ako sa yo doc. I had experienced 5 hrs waiting time before with another doctor. 1st, because she was 2 hrs late from her scheduled clinic hr. 2nd, she only accepts walk in patients to be registered upon arrival. I never returned to her clinic. (18jul31 Feedback)
Linda Veniga I wish most doctors would do the same! Kudos to you Dr Joson.
Here is a Year-end 2018 Summary Report on ROJoson’s NO Queueing, NO Long Waiting Time for Patients:
1. I was late only once (1) in starting my clinic for the whole year in February 2018; I had a prolonged pre-clinic operation; and I gave advance notice to my patients that I would be late. Despite this, the mean waiting time in the session that I was late was still 52 minutes (within the target of no more than 60 minutes) with a range of 37-65 minutes.
2. A total of 19 patients waited for than 60 minutes from the booked appointment time. Range: 62 to 80 minutes with a mean of 66 minutes and a mode of 68 minutes.
3. The range of waiting time from the booked appointment was 0 to 80 minutes. The overall mean waiting time (from booked appointment time) was 7 minutes.
I am happy with the system and my patients are also happy (I hope). The patients do not have to wait for a long time during a patient consultation with me.
I will continue with the refined system of 2019 and I will maintain the target in 2019 - no more than 60 minutes waiting time from the booked appointment time.
I hope those patients who have experienced my system of booked appointment time will validate my above report and give me a feedback.
Dr. Rey
Links:
https://sites.google.com/site/rojoson70memoir/no-queuing---no-long-waiting-time-in-clinic---a-legacy
https://sites.google.com/site/rojosonmedicalclinic/booked-appointment-performance---2017
https://sites.google.com/site/rojosonmedicalclinic/booked-appointment-performance---2016
Rain-Flood-Wind Situation Advisories from ROJoson Medical Clinic (First given out – July 2017)
· What to do when there is strong rain and flood situation – to coordinate with ROJoson whether to go or not to go to ROJoson Medical Clinic
· “These recommendations are made because we are concerned with the welfare of our patients. We don’t like our patients to go to the ROJoson Medical Clinic and, after arrival, just to be told that there won’t be any clinic for the day and that the clinic has been cancelled because of the rain-flood-wind situation. We don’t like our patients to risk the rain-flood-wind situation just to meet their appointment schedule with ROJoson Medical Clinic.”
Medical Prices Data in the Philippines - ROJoson’s Online Publication (started 2012)
In the patient management processes, in deciding on what option for diagnostic tests and treatment procedures to take by a patient, the “medical price” is factored in. ROJoson would factor in the price and would inform his patients. The four parameters used for comparisons for the different options of tests and treatments are benefit, risk, cost and availability or BRCA.
The online posting of Medical Prices Data in the Philippines is for the benefit of the Filipino patients.
May 29, 2019 – the blog is being appreciated blog by the public as shown by the following statistics:
Statistics by Day (from April 11, 2019 to May 29, 2019. Eyeballing – the average is about 50; highest about 80 views and visitors.
Statistics by Month (from January 2018 to May, 2019. Eyeballing – the average is about 10,000 views and visitors.
Statistics by Year (started website in 2012, starting peaking up in 2016) – Eyeballing – the average is about 100,000 views and visitors per year in the last 2 years.
ROJoson established a ROJoson’s Cancer Survivors Registry online site in 2011 to give inspiration to cancer patients with cancer patients looking forward to 10 years or more.
Links:
https://sites.google.com/site/rojosonscancersurvivors/home
https://sites.google.com/site/rojosonscancersurvivors2/home
This site contains brief notes and pictures of cancer patients who have been treated by ROJoson starting 1980 (year ROJ doing general surgery and surgical oncology residency in the Philippine General Hospital) and who are considered "cancer survivors" using an operational criterion of at least 10 years in remission after treatment.
Hopefully, this site and the cancer survivors contained herein will serve as an inspiration to current and future cancer patients and will debunk the thinking that having cancer is always a death sentence.
The cancer survivors contained in this website have given their permission to have their short stories and pictures published for reason of wanting to help others, that is, to give hope to present and future cancer patients. They deserve a "thank you" appreciation.
As of June 19, 2019, I have a registry of 139 cancer survivors who have been in remission for 10 or more years under my care. I will continue to track and increase the number of cancer survivors under my care.
This is one of my end-points in which I can say I have lived a life that matters.
This is one of my legacies to my cancer patients!
ROJoson established the MDH Cancer Crusaders Club in 1988 to provide psychosocial support to cancer patients. This Club is still in existence making it is the longest running cancer support group in the Philippines.
Links:
https://rojosonmedicalclinic.wordpress.com/2012/11/30/cancer-crusaders-club-why-i-formed-it-in-1988/
https://rojosonmedicalclinic.wordpress.com/category/cancer-crusaders-club/
ROJoson has an Indigent Patient Help Program. He gives free consultation or discounted consultation fees when indicated. He operates gratis for those who cannot afford his professional fees; gives big discount on professional fees; allows down payment and post-dated checks for his professional fees; provide surgical materials for free to indigent patients; etc.
ROJoson has online Advocacies and Advisories (partial list):
· Rational Patient Management Process [https://rojosonmedicaleducation.wordpress.com/2017/06/13/maxims-rules-and-guides-in-the-management-of-a-patient-rojoson/]
· No to Routine Circumcision [https://xtulepinoy.wordpress.com/]
· Beware of Santol Seed Swallowing [https://rojosonmedicalclinic.wordpress.com/category/santol-seeds/]
· NO to Unnecessary Operations and Diagnostic Procedures [https://rojosonmedicalclinic.wordpress.com/2017/10/22/rojosons-patients-advised-against-unnecessary-operations-and-procedures-a-registry-a-resumption/]
· Cancer Survivor Registry [https://sites.google.com/site/rojosonscancersurvivors/home; https://sites.google.com/site/rojosonscancersurvivors2/home]
· No to Patient Queueing [https://sites.google.com/site/rojoson70memoir/no-queuing---no-long-waiting-time-in-clinic---a-legacy; https://rojosonwritingsonhospitaladministration.wordpress.com/2019/03/02/feedback-on-rojoson-medical-clinics-booked-appointment-time-system/; https://rojosonwritingsonhospitaladministration.wordpress.com/2016/10/06/no-queues-by-appointment-only/; https://sites.google.com/site/rojosonmedicalclinic/booked-appointment-performance---december-2018-and-2018]
· Legible Physician Handwriting [https://rojosonmedicalclinic.wordpress.com/category/handwriting/]
· Healthy Lifestyle - (actively promoting healthy lifestyle among patients with role modelling) [https://rojoson.wordpress.com/2019/07/03/rojosons-diet-to-stay-healthy/; https://rojoson.wordpress.com/category/exercise/; https://rojoson.wordpress.com/2016/05/30/rojosons-stretching-and-flexing-exercises/]
· Intentional Life Plan – Intentional Living (Intentional Living (promoting intentional living among patients and how to live life to the fullest – how to productive, contented, enjoying, happy and to live long) [https://rojosonnotesonlife.wordpress.com/category/intentional-life-plans/]
· Keeping and Giving Medical Records to Patients [https://rojosonmedicalclinic.wordpress.com/category/keeping-medical-records/
Other Links on Medical Records:
· Medical Recordings in the Medical Clinic
https://sites.google.com/site/rojosontipsforgeneralsurgeons/medical-recordings-in-the-medical-clinic
· Physician Pad in my Clinic and How I Use It
https://rojosonfacebooknotes.wordpress.com/2012/11/02/physician-pad-in-my-clinic-and-how-i-use-it/
· Practice of giving medical records to patients
· Giving duplicate copy of medical records
Some ROJoson’s Medical Practices and Procedures in his ROJoson Medical Clinic:
ROJoson uses telemedicine (through cellphones and FB messenger) to provide patients easy access to ROJoson when needed – pre-consult and post-consult and preoperatively and postoperatively.
He always does a physical examination rather than relies totally on diagnostic tests (at least touch the patient).
He prays with patients before latter are anesthesized for the operation - started July 2019.
He sees and talks to patients before being anesthesized to assure them that he is around and be the one to operate.
He requests his anesthesiologists to have Intravenous fluid line inserted at the operating room rather than at the nursing floor for elective surgery (to avoid multiple punctures by interns and nurses; to prevent repeated puncture when IV gets dislodged during transit from floor to operating room; and to allow patient to rest well prior to operation).
He does his own preoperative risk assessment frowning on routine “cardiac clearance.” He will refer to a specialist only when indicated.
He uses preop and postop antibiotics and other medications rationally and cost-effectively.
He promotes rational and practical care of postoperative wounds such as wounds can be wet, using open dressing, etc.
He checks accuracy of charges to his patients in the operating room. He checks accuracy of hospital bills of his patients.
He does not allow use of unnecessary materials for patient’s use (sometimes stipulated by hospital administration) like ESONEX (P600.00) vs ordinary soap (P20) for full bath before surgery and like Intravenous fluid infusion pumps (he only prescribes this when needed).
He subscribes to the following principles in patient-centered care management:
IMPACT:
ROJoson’s advocacies on patient-centered care management being promoted online, particularly in Facebook, have influenced at least some of his Filipino physician followers (medical students, residents and fellows, and established medical and surgical practitioners) to follow suit thereby improving health care delivery services in the Philippines.
ROJoson’s advocacies on patient-centered care management being promoted online, particularly in Facebook, have influenced at least some of his Filipino patients and the lay Filipino people on what to expect and what to look for in their search for value-based health care services.
ROJoson’s advocacies on patient-centered care management have protected and saved his patients from unnecessary medical procedures and their corresponding expenses and potential complications.
ROJoson’s advocacies on patient-centered care management have empowered his Filipino patients and the lay Filipino people on at least a knowledge on how to have value-based health care services for themselves.
ROJoson’s patient-centered care management has brought about delightful patient experience. Samples of patients’ delightful feedback to me and patient-fans pictures (more on the links provided below):
Links:
Delightful Feedback to ME (ROJoson):
https://www.facebook.com/rjoson2001/media_set?set=a.10151089252480800&type=3
ROJoson-Patient Fans
https://www.facebook.com/rjoson2001/media_set?set=a.10151780396430800&type=3
NOTE: This page was copied (with some editing) from documents submitted by ROJoson to the UPMAS 2019 Awards (September 2019).
See link: https://sites.google.com/site/rojosonupmas2019/patient-centered-care-management
More details on the ROJoson Patient-Centered Care Management Projects mentioned in this page will be amplified in the future (see sidebar).
Also, more ROJoson Patient-Centered Care Management Projects to be added in the future (see sidebar).
ROJ@19oct13;21sept24
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