Minimally Disruptive Medicine

Submitted by Kasey Boehmer

Monthly, we meet to discuss MDM topics. While we often talk about patient capacity as one thing, last month we had an interesting discussion about three different types of capacity:

1) The capacity to fight, particularly when a diagnosis of a chronic illness is given, an acute exacerbation occurs, or another important life event occurs that interferes with the ability to care for an existing condition.

2) The capacity to cope with both the work of patienthood and life. In some ways this is tied with normalizing the work of being a patient in light of competing priorities: making sense of it, planning it and enrolling others for help, enacting the work, and appraising its worth.

3) The capacity to thrive, which consists of the ability to author ones own story and make a meaningful life with and in spite of living with chronic illness. This capacity may follow the first two.

We discussed that these may be sequential but people may also move backwards and forwards between these phases during different points in their journey with chronic illness.

Finally, we briefly discussed the differences and similarities between the Chronic Disease Self-Management Program (CDSMP) and Capacity Coaching, which are both components of a minimally disruptive approach to care. CDSMP deals more with self-management and the capacity to cope with the complexity of chronic illness. Capacity coaching, aims to foster the patient¹s capacity to thrive. It helps people decide what story they want to write, and then asks questions to help them consider if that story is reasonable and how they might get there.