Accepted Type
Oral
Code
OA3-2-3
Acceptance Declaration
Accept
Additional Information
I declare I have no actual or potential conflict of interest in relation to this program.
Was this work accepted for CCME 2020?
yes
Category
General Call (Workshop, Oral Presentation, Poster Presentation)
Type
Oral
Sub Type
Education Research
Will the presenter be a:
Student
Affiliation
Considered for Poster
yes
Title
Rethinking "The [Past] Medical History": An Exploration of Patient Networks of Care Providers
Length of Presentation
Background/Purpose
Patients' networks of care providers have largely been ignored in current models of history taking. That each patient relies on a family physician who helps them navigate the healthcare system is largely assumed. For many hospitalized patients -especially those with multi-morbidity -this may not accurately reflect their reality. Moreover, failing to consider alternative care networks could lead to inadequate care planning.
Methods
Prospective cohort study with data collection and analysis informed by constructivist grounded theory methodology. Data included interview transcripts from 30 patients admitted to an inpatient internal medicine service of an urban academic health centre. Analysis and data collection proceeded in an iterative fashion with sampling progressing from purposive to theoretical.
Results
We found a complex interplay among the types of family physician relationship (highly involved, less involved, non-existent), specialist relationship(s) (highly involved, consultative, fragmented), and patients' personal abilities/social supports. These configurations appeared to impact how each cared for self and navigated the healthcare system. Those with less optimal combinations described many challenges during transitions in medical care arising from hospital admission, new diagnoses, increasing medical complexity, and changes in functional ability.
Conclusion
Our elaboration of the multiple configurations of care networks has implications for teaching history taking. Adapting history taking to more effectively identify care networks can help guide discharge and ongoing care planning for high risk patients. Doing so requires moving from "past medical history" to "chronic active issues," and exploring the associated network of care providers and social context.
Keyword 1
network of care
Keyword 2
medical history
Keyword 3
multi-morbidity
Level of Training
Undergraduate
Abstract Themes
Teaching and learning
Teaching and Learning
- Clinical Context
- Clinical Skills
- Patient Safety
Additional Theme (First choice)
Patient Safety
Additional Theme (Second Choice)
Leadership
Additional Theme (Third Choice)
Authors
Presenter
Laurent Perrault-Sequeira
Term 1
Yes
Term 2
Yes
Term 3
Yes
Term 4
Yes
Term 5
Yes
