3/ Clinical Methods

Question 1

What are the determinants of how someone experience a symptom?

Answer 1

• Sensation (nociceptive, neuropathic)
• Perception (alertness/arousal, distraction, hallucination)
• Mood
• Motivation
• Expectation

Question 2

What are some problems with the biomedical model of disease?

Answer 2

• A lot of symptoms don’t have a pathological basis
• Applying the biomedical model in these cases can lead to harm
• Outcomes depend on many factors external to correct diagnosis and treatment

Question 3

What is DCTA?

Answer 3

Direct to consumer advertising of prescription drugs

Question 4

Distinguish between symptom and disease

Answer 4

• Symptoms are subjective & disease is objective

- Both describe either perceived or observable abnormalities in the body

Question 5

What distinguishes malingering, factitious and somatoform MUPS?

Answer 5

• If symptoms are intentionally produced

- If there is a conscious reason for symptoms

Question 6

What are the four clusters of MUPS?

Answer 6

• Gastrointestinal
• Musculoskeletal
• Cardiopulmonary
• Fatigue/general

Question 7

What are the four basic strategies for decision making?

Answer 7

1. Pattern recognition
2. Hypothetico-deductive
3. Algorithms/branching schema
4. Unfiltered data collection

Question 8

What are the 3 types of hypothetico-deductive thinking?

Answer 8

• Deduction (general to specific) hypothesis > observe > confirm
• Induction (specific to generla) observe > pattern > hypothesis
• Seduction/abdication (Defer to other)
  Problem > ask someone else > fact

Question 9

What are the 2 systems of thinking?

Answer 9

System 1 - rapid, unconscious, retrieval

System 2 - slow, conscious, deliberate

Question 10

What is heuristic-analytic thinking?

Answer 10

• System 1 dominant
• System 2 monitors and can step in
• Need to slow down to reduce errors

Question 11

What is the exemplar for system thinking?

Answer 11

• System 1 first
• No solution?
• System 2 steps in
• Sequential
• Reduce error by gaining knowledge and structured reflection

Question 12

What are some non-cognitive factors that affect thinking? `

Answer 12

• Personal (knowledge, experience, beliefs)
• Affective (mood, relationship, atmosphere)
• Evidence (meta analyses, guidelines)
• Peers
• Patients
• Environment (setting, tools, time)
• Political/society
• Legal
• Desired outcome (implications)

Question 13

What are the 6 domains you need to consider when evaluating a patient’s adherence?

Answer 13

D emographics 
I nstitutional
P hysician related
T echnological
C ognitive 
S ocio emotional

Question 14

Define non-adherence

Answer 14

When patients do not adopt behaviours or treatments that their providers recommend

Question 15

Why is non-adherence important?

Answer 15

1. Treatment efficacy
2. Cost (and opportunity cost) of wasted medicines
3. Need to be able to differentiate between non-adherent and non-responsive

Question 16

Anything that requires increased ___ will reduce adherence

Answer 16

Effort

Question 17

What is an example of creative non adherence?

Answer 17

• Splitting pills to extend dose
• Pill sharing in families
• Supplementing treatments with other treatments
• Double dosing (halve the time)

Question 18

What are some physician based interventions for improving adherence?

Answer 18

• Listen to patient, get them to repeat instructions back
• Simple prescriptions
• Written instructions
• Pill containers and reminders
• Call for missed appointments
• Take lifestyle into account
• Emphasise importance of adherence
• Acknowledge patient efforts
• Involve spouse or partner
• Ascertain worries and expectations
• Probe for barriers
• Share decision making

Question 19

What are some ways of modifying institutional factors to improve adherence?

Answer 19

• Telephone or mail based reminders
• Reduce wait times for appointments
• Incentives (complex), fades once removed

Question 20

What are the 3 subtypes of psychosocial factors important for adherence?

Answer 20

• Psychosocial characteristics
• Social network factors
• Cognitive factors (e.g. beliefs about medication, treatment efficacy)

Question 21

What makes challenging interactions bad?

Answer 21

• Takes up time/resources
• Emotionally draining
• Contributes to stress/anxiety in doctors
• Affects healthcare decisions
• Makes mistakes
• Encourages doctor shopping

Question 22

What are the four elements that influence a challenging interaction?

Answer 22

• Patient
• Doctor
• Illness
• System

Question 23

What is the BATHE technique for challenging interactions?

Answer 23

• Background - what is going on in your life?
• Affect - what do you feel about that?
• Troubles - what about this situation troubles you the most?
• Handling - how are you handling this?
• Empathy - that must be very difficult for you

Question 24

What are the 3 domains you need to be aware of in a challenging interaction?

Answer 24

• Boundaries
• Agendas
• Emotions

Question 25

Why are cues important in challenging interactions?

Answer 25

• Emotions, things half said, things not said

- Help you figure out the patient’s agenda and weave it into your own

Question 26

What is the NURSE strategy for addressing emotion

Answer 26

• Name
• Understand
• Respect
• Support
• Explore

Question 27

What are the steps to managing uncertainty?

Answer 27

1. Empathise

2. Scenario plan