Chapter 10 The consultation and beyond

Question 1

five phases of doctor-patient encounter

Answer 1

1: establishing relationship
2: find reason for patient’s attendance
3: verbal or physical examination
4: consideration of condition of symptom
5: consideration further treatment

Question 2

6 factors for good consultation

Answer 2

1: good medical knowledge
2: achieving good relationship
3: establishing nature of problem
4: realizing patient’s level of understanding for their own condition
5: engaging patient in decision-making
6: managing time - should not seem rushed

Question 3

what shift has been visible in the paradigm of doctor-patient consultation

Answer 3

form professional-centered to patient centered, including them in the decision making process

Question 4

Elwyn’s consultation approach
- define choice, opinion, decision

Answer 4

choice- patient knows what treatment options are available
opinion- providing more detailed information about opinions
decision- supporting the work of considering the preferences and deciding what is best

Question 5

give a reason why many patients leave the decision process completely up to the doctor

Answer 5

this way they don’t take any responsibility and avoid a difficult decision

(interestingly people who paced highest emphasis on their own health, were least likely to want to be included in decision-making process)

Question 6

what healthcare do people feel more free to express their emotions to - doctors or nurses

Answer 6

nurses - more time, more involved in holistic care

Question 7

SPIKES model what is it for?

Answer 7

breaking bad news
setting up interview
perception of patient about their own state
invitation of patient to actually talk about diagnosis
knowlegde and info for patient
emotions are adressed and helped
strategy and summary - clear treatment plan

Question 8

reasons why people forget to take their medication?

Answer 8

forgetting
treatment regimen is too complicated to cope with effectively
social factors
treatment factors
family factors

Question 9

how to maximize medication use in patients

Answer 9

achieving concordance
- provide info in understandable way
- listen and respond to patient in way that encourages decsion-making process

maximize understanding
- appropriate language
- patient prepares questions before setting

maximizing memory
- visual aids
- written info or audiotapes
- emphasize and repeat essential info
simplify language

Question 10

name the methods of interventions trying to maximize medication taking adherence

Answer 10

reminders
convenient scheduling
provide info
reinforcement
family therapy
self-monitoring

Question 11

reasons for non-adherence to behavior change

Answer 11

pain, discomfort
lack of clarity
lack of motivation
lack of time
other diseases
illness representations
self-efficacy