Behavioral for Mini 1 Flashcards
A 68-year-old woman, recently diagnosed with diabetes, is being seen in the primary care clinic. During the medical interview, the patient discloses that she drinks 4 to 5 drinks of rum each night. She states that she likes to drink and is enjoying her recent retirement. According to the Transtheorectical model of behavior change, the physician should guide the patient to which of the following stage of change? A. Pre-contemplation B. Contemplation C. Preparation D. Action E. Maintenance
Correct answer is B.
Because of the patient’s recent diagnosis of diabetes, it is important for the physician to address her nutrition and/or lifestyle behaviors (i.e., modifiable health behaviors). The patient reports that she drinking 4 to 5 drinks of rum each night, that she “likes to drink”, and is “enjoying her retirement”.
These statements indicate that the patient has no intention of changing her behavior (the pre-contemplation stage or Answer choice A).
However, the clinician will want to help this patient understand the risks of her continued use of rum/alcohol (substances that contains high sugar content) versus the positive benefits of treating her diabetes. By employing this patient education strategy, the physician will guide the patient to the contemplation stage (Answer choice B).
A 40 year-old female patient has returned to your office. During her previous appointment she presented with frequent urination, unusual thirst, weight loss and extreme fatigue. A Glucose Tolerance Test (GGT) confirmed Diabetes Mellitus. Upon hearing the diagnosis, she appeared visibly shaken and expressed her fear of disability and dying. Select the physician’s response below which is best used to reflect feeling?
A) “You feel afraid that you will become disabled and die.” B) “Diabetes is a very treatable condition”
C) “Becoming anxious will not help your condition”
D) “I have a lot of experience successfully treating diabetes”
E) “I imagine that these results sound like a death sentence”
Correct Answer: A - Concept: Know the micro-skills of communication and the correct application of these skills for effective communication in a clinical setting
A 27-year-old man in his second semester of medical school is showing a pattern of irresponsible behavior and poor self-care, along with limited insight into his difficulties. According to research, building which of the following capacities would be most helpful in reducing this student’s risk of future burnout?
A) Emotional intelligence
B) A more introverted personality
C) Better study skills
D) Anger management
Correct answer is A. A study of surgical residents found that emotional intelligence was a protective factor associated with lower rates of burnout.
A 35-year-old female physician slams the phone down after receiving a distressing personal call. Unaware that one of her waiting patients is being escorted past her open office door into an adjoining patient room, she exclaims responses to the ended conversation – “That is NOT okay!” “Why?” “Are you serious?” She then starts shaking as she breaks into tears. Seeing the patient’s chart next to her, she grabs it and says, “Let’s get this over with!” and begins stomping toward the patient’s room, still muttering responses to her previous conversation. A fellow physician observes this behavior and decides to act. Which of the following responses best reflects the colleague’s ethical priority?
A) Intervene to prevent the physician from seeing the patient until she is emotionally stable.
B) Report the physician’s behavior to the state licensing board.
C) Call the regional Physician Health Program and confidentially refer the colleague for services.
D) Report the physician’s behavior to the clinic’s supervising physician.
E) Invite the colleague to talk after work, offer support, and facilitate a counseling referral.
Correct answer is A.
The physician’s priority is patient safety, and when observing an impaired colleague, he or she must first remove the colleague from patient contact. The second priority of reporting inappropriate physician behavior would be important it the physician does not remediate her behavior or continues to reveal lapses in judgment and professionalism. Generally an initial report is made to the facility’s designated authority, not the state licensing board. Once patient safety is assured, it is appropriate to follow up with a conversation and possible referral. Consultation with the regional Physician Health Program is a good way to obtain support and advice, and to facilitate follow up if indicated – but again, this is secondary to the more immediate issue of patient safety.
A 42-year-old family practice physician notices that she has become more abrupt with patients and gets annoyed with them instead of feeling empathy. She recently caught herself mimicking an older patient with a disability, and decided to seek help. Which of the following
best describes the burnout sign experienced by the physician?
A) Emotional exhaustion
B) Depersonalization
C) Lack of Accomplishment
D) Free-floating Anxiety
Correct answer is B.
Depersonalization, or “compassion fatigue,” occurs when a physician feels hardened and callous toward patients, resents them, and starts to treat them more like objects than humans. A and C describe other indicators of burnout. D is not specific to burnout.
A mother brings her 20-year-old daughter to the primary care clinic. During the medical examination, the patient becomes agitated and begins to yell. In private, the patient’s mother discloses that, the previous day, the patient violently assaulted a classmate at school. The patient’s mother also discloses that she has heard her daughter talking loudly to herself and that her daughter believes “people are out to get her”. The physician determines that the patient is in imminent danger of causing harm to others. Which of the following is the most appropriate verbal intervention for the physician to make at this time?
A. “I would like to help you by giving you some medication.”
B. “Can you tell me if you suffer from delusions?”
C. “If you do not behave, I will have to call security.”
D. “If you can’t control yourself, you’ll have to see another physician.”
Correct answer is A. Because of the patient’s recent history of violence and current agitated state it would be best align with the patient and help them gain control. Remember, the physician wants to 1) Identify the problem, 2) Recognize the dynamics involved, and 3) Determine which technique(s) may be best applied for a good resolution.
This scenario combines a patient who may be suffering from psychosis and aggressive behavior. In general, patients suffering with psychosis/delusions have poor insight into their illness (Answer choice B). It is important to NOT place the patient under pressure (Answer choice C and D). For patients demonstrating the potential for aggression, it is best to align with the patient – I/we will need to help you to regain control (answer Choice A)
A 29-year old male chief resident has recently made a number of medication errors. His attending physician is concerned, as this is not characteristic of the resident’s performance. Which of the following mental health conditions would most likely account for the resident’s errors? A) Anxiety B) Depression C) Post-Traumatic Stress Disorder D) Narcissistic Personality Disorder
Correct answer is B.
Depression is extremely common among resident physicians, and a study identified that depressed medical residents made six times more medication errors as those who were not depressed. Depression affects memory and concentration, and can increase the likelihood of committing errors. Though anxiety can also impair performance when excessive, moderate levels of anxiety can actually facilitate focus and enhance performance. PTSD is a less likely possibility, and though Narcissistic Personality Disorder may be related to overconfidence, it has not been shown to be related to medication errors.
A patient has not paid her bill for the last three appointments and is now requesting her medical records be sent to another provider. What is the most appropriate way to manage the medical records in this situation?
A. Send the patient another bill using certified mail and explain that their records will not be released until their balance is $0.
B. Send the outstanding balance and medical records to a third-part collections agency.
C. Offer to send a digital version of the medical records since there will not be an additional cost associated with copying them.
D. Release the medical records to the other provider as requested.
Correct answer is D.
Physicians cannot refuse to transfer records requested by the patient (or authorized representative) for any reason. It would not be appropriate to withhold records until payment was made (answer choice A). Although outstanding bills are sometimes sent to a collections agency, the medical records would not be sent to a third party (answer choice B). Medical records may or may not be kept as digital versions in an electronic medical record (EMR) system (answer choice C).
A 24-year-old man is being seen in the campus health clinic. During the medical interview, the patient discloses that he is only sleeping 3 hours each night. The patients states that he “should be getting more rest” but that “it is important to get good grades”. According to the Transtheorectical model of behavior change, the physician should use which of the following strategies to guide the patient to their next stage of change?
A. Educate on risks versus benefits and positive outcomes related to change
B. Develop realistic goals and timeline for Change
C. Identify barriers and misconceptions
D. Provide positive reinforcement
Correct answer is C.
The patient reports that he is “only sleeping 3 hours each night” and that he “should be getting more rest”. These statements indicate that the patient is ambivalent about changing (or is in the Contemplation Stage). In other words, he wants “more rest”, but he also wants to “good grades”. During this Contemplation Stage, a person weighs the benefits of change versus costs or barriers (e.g., time, expense, bother, fear) of change.
In order to guide the patient to next stage or the Preparation Stage, the clinician will want to employ strategies (statements) that help the patient identify barriers and misconceptions (Answer choice C). Inherent in this patient’s thinking is “if I take more time to sleep, I will not get good grades. Answer choice A is for patients in the Pre-Contemplation stage, while answer choice B is employed for patients in the Preparation stage. Answer choice D help patients remain in and/or move to the Maintenance stage of change.
A 44-year-old family practice physician has recently been asking his partners to cover for him in the morning, using various excuses such as “GI issues” and “pounding headache.” One of his partners notices alcohol on the physician’s breath when he returns to work after lunch. If the physician has an alcohol use disorder, which most likely represents the physician’s position on the “loss of function hierarchy”? A) No loss of function B) Early loss of function C) Moderate loss of function D) Advanced loss of function
Correct answer is D.
Work is typically the last domain to be affected by stress and substance use, so even though the problematic behaviors have only recently affected work, they represent an advanced loss of function. The physician’s drinking has likely already adversely impacted his relationships with family members and friends.
A physician is moving her office to a new location and needs to dispose of older medical records in order to “downsize” and move to a more electronic record system. What governing body should she consult in order to determine how long you should keep medical records? A. State government B. HIPAA C. U.S. government D. Joint Commission on Accreditation E. American Medical Association
Correct answer is A.
States have laws governing the length of time that medical records should be kept. The range depends on the type of provider setting (i.e., private practice vs. hospital) and can span between 5 to 10 years. HIPAA is federal legislature that mandates patient and data privacy laws in healthcare. The federal government issued HIPAA, but does not mandate length of time to keep medical records. The Joint Commission of Accreditation is a private organization that evaluates health care organizations for specific healthcare standards, but is not a governing body. The American Medical Association is an association of physicians, but is not a governing body.
A medical school faculty member, concerned about the high rates of burnout among physicians, wants to add training to the curriculum that helps to build skills for minimizing burnout. Which of the following is likely to be the most helpful in this effort?
A) A “Patients First” course
B) Time management training
C) Advanced Electronic Medical Records training
D) Mindfulness meditation training
Correct answer is D.
Taking the “patients first” value too far can contribute to burnout. To prevent burnout, physicians need to prioritize their own health and wellness alongside that of their patients. While training in EMRs and time management might increase job efficiency, they do not address the contributors to burnout. Mindfulness training, gratitude practice and the Healer’s Arts course have all been employed to help increase job satisfaction and reduce burnout risk for physicians.
Describe purpose & components of SOAP note.
SOAP Note Purpose
• Standard format for organizing patient information
• Used for “daily update” or progress note for a patient who has already
had a complete H&P done
• Focused on active problem(s) in a hospitalized patient
• Documentation of an office visit for a specific set of problems
• Focused history and physical examination (not a complete H&P)
– Provides enough information for readers to understand the patient problem, generate an appropriate differential diagnosis
• General format of a verbal report (specific structure varies from service to service, across subspecialties, and inpatient vs. outpatient)
S (Subjective): What the patient tells you – History of symptoms (CC, HPI)
– Relevant PMH, FH, SH ROS
O (Objective): What you observe – PE (findings/signs)
– Any available lab/x-ray results
A (Assessment): What you think is going on – Problem list/differential diagnosis
P (Plan): What you will do
– “Work-up” and/or management plan
A 43-year-old man with diabetes and chronic kidney disease is seen in the ED after a bicycle accident that resulted in minor abrasions and lacerations. After taking care of the man’s wounds, the attending physician is concerned about the man’s kidney functioning and recommends that he be admitted to the hospital to evaluate him for acute renal failure. However the man is adamant that he feels fine and just wants to go home. What is the best next step for the physician to take?
A. Document that the man is leaving “against medical advice.”
B. Warn the man that if his kidneys are in fact failing he could die.
C. Ask the man why he feels so strongly about leaving, explain the potential consequences, and emphasize the benefits of further hospitalization.
D. Involved the man’s spouse or next of kin to convince him that further evaluation is in his best interest.
E. Warn the man that if he attempts to leave he will need to be restrained.
Correct answer is C.
When faced with this situation it is best not to coerce, threaten or scare patients into staying. It is important to find out what is motivating the patient’s choice, listen to grievances, attempt to restore the therapeutic alliance, and explain risks/benefits. If the patient still wishes to leave then, it would be important to follows standardized procedures for documenting what occurred and ensure that the patient is making an informed choice.
A 45-year-old Caucasian woman presents with worsening abdominal pain. She reported experiencing worsening pain over the last two weeks and has no prior significant medical history. In the medical record, the resident dictated her medical history as including hypertension incorrectly and this was found after the note was electronically signed. What is the best way for the attending physician to proceed?
A. Apologize to the patient for the error and notify the referring provider.
B. Discuss the error with the resident and ensure that he does not make this mistake again.
C. File a formal report with the Joint Commission on Accreditation on behalf of the resident.
D. Add an additional note or “addendum” clearly documenting the error and the correct information.
E. No action needed unless the patient requests the records or to transfer records to a specialist.
Correct answer is D.
If an error is made, an additional note or “addendum” should be created documenting the error and the correct information. If the note has already been forwarded to another provider, it is important to inform the other provider as soon as the error has been realized.
