Dit document bevat alle lessen van Inleiding tot de patiëntenzorg van het vak 'Vaardigheden en communicatie 2', gegeven door Prof. Schoenmakers, Prof. Van Nuland en Prof. Goffin
Hoofdstuk 1: de zieke mens .............................................................................................................................. 4
Inleiding ........................................................................................................................................................ 4
Eerstelijnszorg ........................................................................................................................................... 4
Huisarts (HA) ............................................................................................................................................. 6
Huisarts en klinisch redeneren ...................................................................................................................... 6
Theorema’s van Bayes ............................................................................................................................... 6
Humanisme en intuïtie .............................................................................................................................. 7
De huisarts en klinisch redeneren: de patiënt georiënteerde methode....................................................... 7
Competente arts vs expert ........................................................................................................................ 7
Verloop klachten ........................................................................................................................................... 8
Premedische fase: wat gaat vooraf aan een consultatie? ........................................................................... 8
De zieke mens: 5 invalshoeken ...................................................................................................................... 8
De rol van de zieke .................................................................................................................................... 8
Het verhaal van de patiënt ...................................................................................................................... 10
Ziekte vraagt aanpassing ......................................................................................................................... 10
Zelfmanagement ..................................................................................................................................... 10
Gezondheids-alfabetisme ........................................................................................................................ 11
Hoofdstuk 2: de arts-patiëntrelatie ................................................................................................................. 12
Inleiding ...................................................................................................................................................... 12
Consultatie.............................................................................................................................................. 12
Eerste deel van de consultatie ..................................................................................................................... 12
Aanmelding ............................................................................................................................................. 12
Oriëntatie................................................................................................................................................ 13
Anamnese ............................................................................................................................................... 13
Het klinisch onderzoek – het technisch onderzoek ................................................................................... 13
Tweede deel van de consultatie .................................................................................................................. 14
Beleid...................................................................................................................................................... 14
Afsluiten ................................................................................................................................................. 15
Communicatie in tweede deel ................................................................................................................. 16
Bijzondere situaties in consultatie ............................................................................................................... 16
Wat vinden patiënten moeilijk? ............................................................................................................... 16
Wat vinden artsen moeilijk? .................................................................................................................... 16
Shift of paradigms ....................................................................................................................................... 16
Evidence based medicine (EBM) .............................................................................................................. 17
Patient-centered medicine ...................................................................................................................... 17
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, Belang arts-patiëntrelatie............................................................................................................................ 17
Competente communicator..................................................................................................................... 17
Sleutelboodschappen .............................................................................................................................. 18
Hoofdstuk 3: chronische ziekte ....................................................................................................................... 19
Inleiding ...................................................................................................................................................... 19
Paradigmaishift: cure → care .................................................................................................................. 19
Chronische ziekte ........................................................................................................................................ 19
Onderscheid ziek en gezond .................................................................................................................... 20
Chronisch traject ..................................................................................................................................... 20
Complexe zorg is gepersonaliseerde zorg................................................................................................. 21
Zorglevels voor chronische ziekte ............................................................................................................ 21
Zorgcoördinatie en gepersonaliseerde zorg ................................................................................................. 21
Chronic care model van Wagner .............................................................................................................. 21
Voorwaarden voor gebruik van zorgtraject .............................................................................................. 22
Zorg en gezondheid: samenwerking ............................................................................................................ 22
Demografie ............................................................................................................................................. 22
Zelf-management........................................................................................................................................ 23
Patiënt-empowerment ............................................................................................................................ 23
Voorafgaande zorgplanning ..................................................................................................................... 23
Hoofdstuk 4: patiëntenrechten ....................................................................................................................... 24
Informed consent........................................................................................................................................ 24
Arbeidsongeschikt....................................................................................................................................... 25
Fasen ...................................................................................................................................................... 25
Attest ...................................................................................................................................................... 25
Medisch getuigschrift .................................................................................................................................. 26
Beroepsgeheim ........................................................................................................................................... 26
General Data Protection Regulation (GDPR)............................................................................................. 27
Hoofdstuk 5: zorgoverleg ................................................................................................................................ 28
Patiëntenbehoeften .................................................................................................................................... 28
Chronic care model ..................................................................................................................................... 28
Ondersteunen patient empowerment ..................................................................................................... 28
Ondersteunen beslissingen...................................................................................................................... 28
Organisatie van zorgverleningssysteem ................................................................................................... 29
Klinische informatiesystemen .................................................................................................................. 29
Ondersteunen lokale gemeenschap ......................................................................................................... 29
Organisatie van gezondheidszorg ............................................................................................................ 31
Huisarts spil in chronische zorg.................................................................................................................... 32
2
,Verwachtingen van patiënten naar artsen ............................................................................................... 32
Basisgezondheidszorg.............................................................................................................................. 33
3
, INLEIDING TOT DE PATIËNTENZORG
HOOFDSTUK 1: DE ZIEKE MENS
INLEIDING
EERSTELIJNSZORG
- Multi-professioneel team
o Psycholoog
o Verpleegkundige
o Tandarts
o Sociaal assistent
o Ziekenhuisspecialist
- Proactieve + reactieve zorg
- Focus op populatie + individu
o Context en epidemiologie
- Sociale en culturele context van de patiënt
o Noden, wensen
o Interpretatie en beleving
- Patiënt staat centraal in de zorg
- Advocaat van de patiënt → ondersteuning in alle opzichten
- Multiple zorgmodellen → individueel verschillend, complexe zorg
BASISWAARDEN
- Holistisch
o Fysiek
o Mentaal
o Socio-economisch
o Cultureel
- Gebalanceerd
o Kennis
o Visie van professionals en patiënt op ziekte/gezondheid
o Actieve interventie
- Patient-centered
o Gepersonaliseerd zorgaanbod
- Rigoreus
o Evidence – practice
- Billijk
o Rechtvaardig
o Toegankelijk voor iedereen
- Reflectief
o Omgaan met onzekerheden
o Reflecteren op beslissingen
4
, ALGEMEEN MODEL
Traditioneel zorgmodel Hedendaags zorgmodel
Diabetes: ziekte van de pancreas Diabetes: multi-facettair probleem met impact op
verschillende systemen
- Biomedisch
- Psychisch
- Sociaal
Oorzaak: schade in pancreascellen Oorzaak: complexe interactie tussen
- Nature
- Nurture
- Culture
Focus management: Focus management:
- Insuline - Partnerschap
- Therapietrouw - Individueel zorgplan
- Aangepaste opleiding
- Ondersteuning levensstijl
- Secundaire preventie
- Verwijzing
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