Clinical Medicine Flashcards

Question

What is a disadvantage of assays?

Answer 1

assays will not cover all genotypic outcomes (e.g. if patient has a rare variant that affects metabolism, then it might not get caught)

Answer 2

Diplotype tables (a.k.a translation tables) detail the potential outcomes for combinations of diplotype: will tell you dosing information based on alleletypes of patient

Answer 3

To optimize the drug dose so that the patient’s drug concentrations remain within the therapeutic range; generally performed when drug reaches steady-state

Answer 4

Known relationship between dose & blood/serum/plasma concentrations Narrow therapeutic window High patient variability in pharmacokinetics Severe adverse effects

Answer 5

adds outside-the-visit chronic care management (often done by non-physician team members).

Answer 6

Medicare reimbursed with the focus on acute, episodic care

Answer 7

lower cost, better care and better health | health care and community provide interactions between informed/activated patient and prepared proactive practice team

Answer 8

Personal Physician - each patient has an ongoing relationship with a personal physician trained for first contact and continuous care. Physician-directed medical practice - personal physician leads a team of individuals at the practice level who take responsibility for the ongoing care of patients Payment and Med Economics: payment appropriately recognizes the added value provided to patients who have a PCMH and work that’s done outside of face-to-face. Quality and Safety - advocacy for attainment of optimal, patient centered outcomes defined by a collab care planning process. EBM and CD support tools guide decision making - QI is key here. Whole person orientation - physician responsible for the patient’s: health care needs, learning of self-management principles, and arranging f/u care Enhanced access to care -- access is available through systems such as open-access scheduling, extended hours, and new options for communications between patients and staff. Care coordination and integration - care coordinated across all elements of the health system facilitated by tech to assure they get the care when they need it. (PPP-QWEC)

Answer 9

Ask: assess the pt’s baseline knowledge Tell: use simple, clear, concise language; avoid medical jargon; speak slowly; “chunk” info by pausing after a concept; limit 1-3 key messages and emphasize these messages; use visual aids and written instructions to reinforce key messages. Ask: request teach-back (ask the pt to repeat the instructions they have just been given); expect questions: “What questions do you have?” instead of “Do you have any questions?”

Answer 10

``` Optimize outcomes (better outcomes if patients know what’s going on/why the plan is the way it is) Promote pt autonomy by allowing patients to share in decision-making Promote pt self-efficacy ```

Answer 11

A strategy of partnership between doctor and pt that helps pts make “an evidence-based treatment choice”

Answer 12

appropriate for preference-sensitive conditions in which there is more than one choice of therapy, including the choice of no intervention

Answer 13

adherence to medication, smoking cessation, diet and exercise, risky sexual behavior, alcohol use disorder, blood pressure

Answer 14

``` OARS: Open ended questions Affirmative statements Reflections Summary statements ```

Answer 15

When the physician tells the patient how to fix a behavioral problem

Answer 16

It is best to sidestep any resistance and to avoid trying to fix and solve every problem

Answer 17

Highlight areas of inconsistency between behavior and goals or values

Answer 18

Think about costs and benefits of changing behavior vs. not changing behavior