Clinical Topics Flashcards
Profession
a vocaiton requiring knowledge of some department of learning or science
Learned Profession
any of three vocations ot theology, law, and medicine commonly held to require highly advanced learning
Profession vs Trade
Training Intellectualism Autonomy Judgement High Stakes Decision Service over self interest
Training
Profession vs Trade
extensive time understanding not obtainable unless by specialized school skill set under scrutiny as training complex work
Intellectualism
Profession vs Trade
integration of knowledge, skill and clinical thinking
use of rigorous self evaluation
Autonomy
Profession vs Trade
need to conduct work byself
members determine limits of rules
practice and compentency standards
Judgement
Profession vs Trade
extrapolated from education and training
deferals are expected by peers
High Stakes Decision
Profession vs Trade
decision cannot be received elsewhere as a result imoproving society
Service over Self Interest
Profession vs Trade
client/patient first
have a central mission
pro bono are a part of sevice
Training
Who is a Professional
undergrad is vetting process to see ability to withstand professional program through repetitive channels, internship and residency
Intellectualism
WHo is a Professional
practice and day to day tasks
manage people and problems that are complex and uncertain
amendable to evaluation
continuous learner, always learning and improving
aware of areas of controvesy in profession
demonstarte mature tolerance for difference of opinions
Autonomy
WHo is a Professional
function without guidance
abides by rules of conduct and compentancy
considers whats right over popular and profit
Judgement
Who is a Professional
demonstrate skills and effectiveness over time
High Stakes Decision
Who is a Professional
able to demonstrate correctness and objectivity in difficult circumstances
Service over self interest
Who is a Professional
client / patient first
advocate for what is best
pro bono serice
Patients - Baby Boomers
may not resonate with the traits and preferences you claim as your generational norms
your patients are impressed by smarts, but they want to connect
gain their trust
Professionals presenting themselves
with dignity integrity compassion and authority
Where to start professionalism
be comfortable in your own skin
practice on classmates
practice on campus community
see world outside thru lens of person who leads by example
Professionlism in student-student interaction
cavility duty to offer respect and dignity, be tolerant, disagreement can be dialogue or debate rather than conflict, harassment
Professionalisms in studnet campus interaction
learn to be circumspect view the issude as a series of perspectives express yourself with authority be kind and respectful public expects you to be dignified
Confronting Unprofessionalism
be professional
privacy is essential part of respecting the person
inquiry to understand facts
clarity and circumspection in expression of your own facts
look for oppurtunity to resolve it
Confronting Unprofessional Behavior
I AM NOT SURE I CAN HANDLE THIS
first be professional
objectively consider your state of agitation
inquire to understand facts,s perception and assumptions
look for opputunity to resolve the problem
Professionlism in student outsider interaction
the state law and treating, diagnosing and other practice issues without supervision
practice without faculty supervision is illegal
recommendation of nutrictional supplements or other lifestyle changes is risky
providing diagnosis is illegal
Communication by audience
non-directed communication
directed communication - Large group, small group, interpersonnal, intrapersonnal
Communication by sender
verbal - monologue, dialogue, discussion, debate, arguement
non-verbal- body language and written
Examples of non-verbal communication
facial expressivity figity or nervous twitch eye contact head nodding hand gestures postural position paralinguitic speech characteristics dialogue behaviors such as interuptions
What Non-verbal communication is conveying
empathy caring paying attention agree or disagree your judgement boredom
Verball vs non- verbal
75% of Dr/ Pt interactions
22% of human quality conveyed in tone
55% is conveyed by visual perception
What is caring to patients
communicate effectivelty - active listening, give information in right doses, choose words carefully, direct and straightforeward, soft but confident
be empathetic - offer measured empathy, empathetic statements
arrange to meet health care needs - help move with next steps, preserve patients autonomy
respectful and non-judgmental - know patient but focus on problem, offer hope
Empathy
- to put oneself in anothers shoes
- identify and recognize anothers emotional state
- cognitive empathy, recognize anothers perspective or mental state and respond appropriately to that state
- characteristics of empathy, recognize and understand anothers viewpoint, adopting or internalizing the perspective of the indivdual, ability to interact in way that honors the changing experience
Demonstrationg Empathy
recognize patients feelings in moment
imagine how they might be feeling
reflect back to patient on these feelings
make an effort to legitimize that feeling
offer support and partnership
Reflection/Name emotion
you sound upset
you appear afraid
this situation really seems to have you worried
you seem uncomfortable am I reading you right
Validation and Understanding
anyone would be upset about having to wait
i can understand that your frustrated with the healing progess
yes, healthcare is expensive
Partnership/Support
perhaps we could work towards the goal
I am ready and willing to put this situation behind us
I understand importance and focus on this first
Respect
Im interested with how they’ve handles dietary changes
while i respect the decision i hope you quit smoking
Active Learning
eye contact
postural position
verbal quality
verbal messages
3 Components of Empathy
cognitive - enter patients perspective
affective - put yourself in patients situation
action - feedback that validates, clarity, respect
Patient Barriers to empathy
uncomfortable with decision
not in touch with or understand experience
hard time expressing self
worry about becoming emotionally overwhelmed
identity roles conflict
Dr. Barriers to empathy
to draining tiime consumption concern over loss of control uninterested in patients experience belief feeling they cant fix discomfort discussing emotions identity role conflicts
Managing Empathy
Too much - burn out and boundaries
Too Little - patient compliance, unsatisfying, relationship, misunderstanding, increased potential for malpractice
Sympathy
empathy at the next level
emotional state not ebjective
self perception and expression of pity or sadness
feeling sorry for patient
Things that masquarade as empathy
sympathy
identification
pity
Identification
community or socilogical conectivity
sense attributes of self as cahracteristics of patient
personal identity into another
losing objective attention
personal association with experience of patient
conter-transference with patient
Pity
based out of sympathy
elements of insincerity ot condenscension to patient
sensed of negative version of empathy
Ethical Foundation
Beneficence - doing whats best for patient
Non-maleficence - avoiding deleterios things
Autonomy - ensuring properly informed choices
Justice - ensuring fairness in distribution of cost, quality and management
Physician Duties of Informed Decision Making
must tell the truth
explain comlicated health information at the appropriate levels
be able to answer questions
theraputic priviledges, witholding info that may be damaging
PD of Informed Consent
difference from IDM, agreement to perform practice
requires clear definition of PARQ
Oregon Law requires informed consent
PARQ
Procedures to be done
Alternative to those procedures
Risks
Questions
PD to Minimize Preventable Disease exposure
protect patient from uneccessary exposure to risk or disease
duty to protect self from uneccessary risk
PD to keep a Health Record
health car record should be, accurate complete and organized, secure, confidential
property of physician of employer but information belongs to the patient
PD to Third Party Evaluation and Expert Witnesses
dissclosure to patient or court the exact role and who you are working for
offering candid, honest and complete opinion
accurate recount of credentials and skills
avoidance of expression or partisan or biased outcomes
Gift
context is everything
Gift value is always significant
what is the reason for the gift
is it a personal gift
