"All new laws, though penned with the greatest technical skill, and passed on the fullest and most mature deliberation, are considered as more or less obscure and equivocal, until their meaning be liquidated and ascertained by a series of particular discussions and adjudications." THE FEDERALIST No. 37 (James Madison)
Today’s society (US) is characterized by a set of complex problems — such as inequality, climate change, gun violence and affordable access to healthcare to list a few— that are seemingly intractable. People have looked to traditional societal institutions — like government agencies and advocacy groups — to tackle these problems, and they have become frustrated by the inability of these institutions to act effectively and legitimately. Unsurprisingly, trust in existing institutions is at an all-time low. To survive and flourish in the 21st century our nation must embrace the digital revolution that has transformed most aspect of personal and social life. Current technology allows us to rewire the body politic through information technology. These tools allow unprecedented opportunity to get access to information, mobilize, challenge misinformation provide for a more deliberative dialogue. What is needed however, is a framework for meaningful dialogue and deliberations.
The Medical Case Presentation represents a framework that summons our fellow citizens to address the challenges confronting us as individuals, as communities and as a nation. The Medical Case Presentation has evolved as an essential framework and structure for a focused and disciplined approach to clearly present, define, and collaborate in addressing medical problems. Healthcare professionals use the medical case presentation to identify, analyze, develop, implement and monitor a solution based “treatment plan.” When used effectively, it allows healthcare professionals to communicate and share information among clinicians and other stakeholders of varied clinical disciplines to develop testable hypotheses for simple and complex problems. The framework allows for clearly identifying pathologies and providing objective data to support the diagnosis and “treatment plan” (including biological, psychological, social and spiritual factors). The Medical Case Presentation is uniquely positioned to address systematic changes over time. Through progress notes addressing specific problems, practitioners are able to adapt to new issues and data to clearly identify problems and potential solutions.
When adapted to the non-medical world, the Medical Case Presentation provides a well-established framework useful in addressing complex and multi-factorial issues that carry life and death consequence. The framework is particularly effective in situations that require intervention in the face of uncertainty. The medical case presentation confronts uncertainty and lays out a plan to achieve the best possible results. The medical case presentation draws people in to objective and non-partisan dialogue built on an accepted understanding of the challenge, reliable data, openness, transparency and participation. It supports people in exploring the various elements contributing to a problem in order to generate a situational diagnosis and establish a meaningful treatment plan that is monitored over time. The Medical Case Presentation includes multiple features to engage citizens. Similar to the diagnostic and treatment tools in the hands of medical clinicians, these features can be thought of as a toolbox for citizenship (Can describe elsewhere). As data associated with the problem change, new information is gathered or new treatments become available, the case is easily updated.
The Medical Case Presentation structure offers a framework for a citizen-oriented treatment plan that provides a
comprehensive, multi stakeholder and multi-phase road map for citizen involvement in their political ecosystem. The medical case presentation process encourages citizens to engage in a healthy action-oriented collaborative process that addresses the complexity of the social and political challenges confronting our nation. Using the medical case presentation promotes objective and nonpartisan dialogue built on openness, transparency and participation to explore the various elements that contribute to a problem in order to generate a meaningful treatment plan. Associated psychological issues including cognitive biases, needed incentives and triggers for negative emotions are identified and explored in order to minimize their negative impact and maximize their positive potential. Through progress notes addressing key assessment goals, we are able to adapt to shifting factors to continually address new situations and create potential solutions.
I limit my focus to the following aspects of the medical case presentation: the values (vision), symptoms, history of the present condition, current treatment, review of systems, data and information, diagnosis, treatment plan and progress notes for the challenges of the “body politic". Additionally, The Medical Case Presentation includes multiple features to engage citizens. Similar to the diagnostic and treatment tools in the hands of medical clinicians, these features can be thought of as the toolbox for citizenship.
Framing the discussion:
How can we all, including the private sector, non-profits, government and citizens, best achieve effective solutions to the challenges facing our nation i.e. opioid use and misuse and the related issue of pain management?
Components of the Medical Case Presentation
The structured components of the medical Case Presentation provide a language and framework for systematic process and dialogue to address medical challenges.
Identifying Information: This identifying information section provides identifying information of the problem (person/ system/challenge/ symptom) that is the subject of the case presentation.
Chief Complaint: The chief complaint section describes the problem to be addresses in a brief concise manner. Usually it reflects what the patient is stating as their problem.
Presenting Problem: The history of present condition section addresses the problem in more detail providing a timeline and associated systems and impact of the problem presented.
History of the Present Condition: The history of present condition section addresses the problem in more detail providing a timeline and associated systems and impact of the problem presented.
Current Treatment: The current treatment section will be used to describe the various plans that are currently used to address the problem.
Current Services: The examination of current services section will provide data that is associated with the functioning of the Pain and Opioid use related services .
Past Treatment: The prior treatment and response by problem section will highlight prior efforts addressing the challenges of pain and opioid Use related issues.
Review of Systems: The review of systems section will examine the various stakeholders, and describe their interests, motivation, resources and prior input into addressing the challenge of opioid use.
Data: The data section will provide data that is associated with the various aspects of the Pain Opioid Epidemic and the “War on Drugs”
Problem List: The problem list section will review the problems identified and will discuss their importance for reform.
Differential Diagnosis, Assessment and Discussion: The differential diagnosis section reviews the various general categories that impact addressing the challenge of opioid use.
Treatment Plan: The treatment plan section describes the process we will utilize to achieve our mission, listing goals and clearly defined milestones toward our vision.
Outcomes and Monitoring: Periodic follow up to assess the status and adjust the treatment plan.