any Flashcards
What are the components of a professional?
Requires a mastery of a complex body of knowledge and skills. It requires competence, integrity, morality, alturism, and the promotion the public good within that domain, self care
What is the hidden curriculum?
It is the sum of unwritten rules, influences and attitudes students acquire from other students/teachers/doctors in the clinical learning environment.
It is the culture of medicine.
It is the impact of the attitude of the hospital faculty on the behaviour of the student, positive or negative.
Students are more likely to participate in a behaviour if observed and once participated in are more likely to judge behaviour as professional
What is the formal curriculum?
What is stated and assessed
What is the informal curriculum?
Serendipitous learning that is often tutor/student specific, not captured in the formal curriculum.
What is palliative care?
Specialised care for people with a serous illness. It aims to provide relief from symptoms and stress of a serious illness. Th goal is to improve the quality of life for both the patient and the family.
It can be provided along with curative treatment.
What are the roles of a palliative care team?
- symptom assessment and management
- psychosocial assessment and management
- spiritual/cultural assessment and management
- communication and shared decision making
- advanced care planning
- coordination ad continuity of care
- appropriate palliative care/hospice refferal
Carer support - end of life care
what are the benefits of palliative care?
Reduced pain and symptom distress
Improved health-related quality of life
Improved patient family satisfaction
Increased likelihood of death occurring outside of the hospital
Reduction in costs/day and in length of hospital ICU stays.
What are the four regions of palliative care?
Physical e.g. cancer, drug toxicity, effusions
Psychological - anxiety, disappointment coping
Social, e.g. spouse, children
Spiritual e.g. suffering
What happens when someone is dying?
Profound weakness
Reduced intake of food/fluid
Difficulty swallowing
Bed bound
Peripheral shutdown ( cold hands and feet)
Poor improvement to medical interventions
Near-death awareness
Increased sleepiness
Pallor of nose andtop of ears
Cardiovascular changes and respiratory changes
What is a MSE?
mental state exam
- structured
It assess:
1) Appearance (age, gender, race, build, hairstyle, health and hygiene, dress, physical abnormalities).
2) Behaviour (eye contact, cooperativeness, motor activity, movements, gestures)
3) cognition - MOCA and more specialised tests. Alertness, memory, orientation (place and time), concentration, abstract idea.
4) speech - rate, articulation, volume, quantity, response time, tone
5) Mood/affect - depressed, angry, euphoric, range and intensity, stability, appropriateness
6) thought process - goal directed and organised, amount or speed, poverty of thought, flight of ideas, tangential, word salad
7) Thought content - delusions (religious, morbid jealousy, grandiose, guilt), delusions of persecutions), thought withdrawl, thought broardcasting, thought insertion, phobia, obsessions,
8) Perception - hallucinations, illusions, depersonalisation, derealisation
9) suicide
10) insight/judgement - capacityto organise and understand the problem, symptoms or illness, medication
11) Risk - to self or others, also from neglect
Have to ask about sexuality, homicidal thoughts, date, conversational questions
What is a delusion?
A fixed false believe outside of the cultural norms
When to take a sexual history?
If someone requests a sexual health check.
If someone is a contact of an STI
Symptoms of - genitals, urinary, lower abdo pain, ano-rectal symptoms, rash
People under 29
Antenatal
Contraception
Smear
What to do and ask when taking a sexual history?
The 5 Ps
Permission Privacy Past - past STDs Partners - male or female Pregnancies - histories and plans Practices - type of sex Protection
Get privacy (even at hospital). Ask to talk to the patient alone.
Let the patient know that the conversation is confidential, unless there is a serious risk of harm.
When did you last have sex?
Was that with a regular partner?
Male or female?
For females, have any of your male partners ever had sex with another man?
Was that oral, vaginal or anal?
- if man having sex with man, ask if they were bottom, top or versatile.
Protected or unprotected?
In the last 3 months, how many people have you had sex with? (then regular/casual, protected, male/female, oral/vaginal/anal)
How many people have you had sex with in the past year?
Have you ever had sex with a man?
Have you or your partners ever used i.v drugs?
Have you or your partners ever worked in the sex industry?
Have you ever had sex with someone overseas?
Has anyone ever made you have sex in a way you didn’t want?
Any past STI?
- smears, periods, pregnancy, breastfeeding, contraception
Ask about past medical history
Ask about medications and allergies
Ask about alcohol and drugs
What is sex diversity?
Someone who has diversity in their sexual development
What is an effective method for approaching substance use?
Be non-judgemental Understand the potential reasons for substance abuse Understanding addiction Appraising the patients substance use Knowledge of the support services Persevere Care Routine screening - normalise Find a hook - family, finances family
Questions to ask about substance abuse?
What are some of the good things about smoking? what are some of the bad things?
Repeat that back.
What is the ABC approach to smoking cessation?
Ask all patients
Brief advice to all patients who smoke
Cessation support (a combination of behavioural and medicine)
What are the steps of addiction? Wheel of change
Precontemplation
Contemplation
Determination
Action
Maintenance - come to terms with being drug free
Relapse
What is motivational interviewing?
Enables work with people who have little or no motivation to change
Expressing empathy Reflective listening Avoiding argumentation Rolling with resistance Supporting self-efficacy (their ability to do the right thing).
Motivational interviewing is an approach which can be used for patients who are pre-contemplative and allows you to enter a conversation as a naïve enquirer without any expectations.
Roll with the patient’s resistance to make change, express genuine empathy, listen intently while gently developing discrepancies and support their self-efficacy to come to their own conclusions.
- a conversation about change
- collaborative
evocative and seeks to work with the persons own motivation and commitment to change
Rolling with resistance Express empathy Supportive self-empathy Don't assume Have compassion
Consider the roles of family
What might be influencing behaviours?
Beliefs, values, thinking, emotions, these effect the behaviour, which effects the outcomes that we produce.
Patient: personality, attitudes, illness behavious, culture
Doctor: burnout, distracted, depressed, junior
Illness - complexity, chronic, treatable
System - economic, health system, isolation, relationships
What is transference?
Unconsciously transfer feelings and attitudes from person or situation from past onto person or situation in present
What is countertransference?
Response that is elicited in the therapist by the patients unconscious transference communications
We need to reflect on this.
What should you do with a challenging situation?
REBELS
Recognise it- Find out what is going on for them/ what the issue is?
Empathise
Boundry setting
Empathesis with the pathients interests - Find a common ground
Language inclusive
Solutions - Look for solutions together
Remember to respond to the emotion before giving information
What are things to say to an angry patient?
Say: I can see you are really frustrated Can you help me understand what has happened Gosh I can see why you are so upset. I am really sorry.
What are things to say to a distressed patient?
I can see this has been overwhelming for you……. (keep quiet)
Are you able to tell me what is going through your head.
Be gentle, tentative, give space
What do you do with a talkative patient?
Be professional
Acknowledge what they are saying and how important it is to them
Gently redirect and state why
Give them a time frame or a focus.
Haven’t got so much time today, what are your two things you would like to focus on most
What do you do with a talkative patient?
Differential diagnosis - deaf, sad, upset, angry, withdrawn
Say:
I notice that you are not saying much, I am wondering what is going on for you? Would there be a better time to talk?
What do you do with an offensive patient?
Ignore/divert/challenge/report
We don’t tolerate that kind of speech here
Lets keep this professional
I’m leaving because I don’t feel comfortable.
Tell me what you are worried about?
Supportive statement about colleagues if they are the issue.
What are the issues with using an interpreter?
Difficult building rapport.
May have technical errors in translation.
Different meanings to different languages
One work in chinese may mean something else in english. For example, cold means poor energy
Difficult to introduce effectively
