Comms 8 Flashcards
What is whole patient medicine?
Holistic approach, treating patient as an individual, ICE.
Biomedical model WITH psychosocial model
How do we have a whole-patient approach in our consultations?
ICE
Ask open questions? Everything not just symptoms.
Plenty of time/space to talk
Social history and context.
Remember the patient as an individual – Not contact with healthcare services very often.
Not just about the disease.
It’s about the context.
When is whole-patient medicine difficult in consultations?
Language barriers
With certain types of patients – Internal and external controllers, powerful others.
Mismatch on views and ICE.
Cultural differences - belief in mental health, depression, contraception
When the patient is in denial
Mental capacity (Very specific)
Mental health (Acutely unwell)
Young people (distractions from technology, see the clinician as authority figure so not easy to share decisions)
When there is failure in our communication
When the patient is rushed into difficult decisions (in both GP and acute hospital rounds)
When and how is consent for surgery given?
Risk of greater than 1% or is significantly life altering or threatening.
All patients are entitled to the same info and they need to have the info to make informed decisions.
Not false reassurance or false information.
More is good, up to a limit – leads to decreased anxiety about procedures, improves blood sugar control in diabetics, improved compliance with medication and improved trust in clinician relationships.
How should we go about making decisions in a patient consultation?
Check understanding
Having knowledge
Engaging the patient
Talk it through
Hypothesis formation
Test hypothesis – proving or disproving it through asking questions to avoid confirmation bias.
Dual process theory – System 1 (Automatic and fast) and system 2 (Slow and analytical).
What is the the Bolam Test?
You must act in accordance with a practice accepted as proper by a body of responsible and skilled peers.
Acting in a way that would seem reasonable for the professional at that stage in their careers and position.
If they would do the same thing or act in the same way.
It is recognised that the amount of info offered is also patient specific (must capture and document all info).
What is implied consent?
For things like bloods or more minor procedures ie they give you their arm.
Verbal consent is fine so still ask permission and check that it’s okay.
What is the Mental Capacity Act?
Governs decision making for adults who may not be able to make particular decisions, including:
- Learning difficulties.
- Illness (Dementia)
- Mental Health
- Physical Difficulties (ie MS)
It is situation and decision specific in many cases – Based on patient specific and also situation and place decision within each patient.
There is presumption of capacity.
Individuals should be supported to make decisions and given time to.
People have the right to make unwise – Might not agree but have to respect it.
Best interest is key.
Must consider least restrictive options (Best interest meetings).
How to assess the mental capacity of a patient?
Stage 1: Is there an impairment or disturbance of brain function?
Yes – Go to stage 2
No – They have capacity
Stage 2: If unable to do any 1 of the following:
Understand info given to them
Retain that info long enough to be able to make the decision
Weigh up the info available to make the decision
Communicate their decision – This could be talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.
How to prevent errors in patient care?
Proper reassessment at each stage.
Double checking medications and their doses.
Reconsidering differential diagnosis.
Don’t assume the patients before picked up all info.
Stay up to date with key medication alerts.
What are some Cognitive Forcing Strategies for Improved Performance?
Consider alternatives - routinely think about what the other options are if the initial diagnosis is wrong.
Seek incongruent data - reframe when recording
Reconsider dissonant facts - take a step back from the problem.
Know and understand test accuracy - tests are only as good as the questions you ask of them
Important to think that tests are just a snap shot – look for trends.
Use time as a diagnostic tool- watch and wait isn’t the same as doing nothing.
Heighten our metacognition - step back from the problem to reflect on the thinking and reflect on the affective process.
Decrease reliance on memory - use cognitive aids – decision support, mnemonics, guidelines, algorithms etc wisely.
Be aware of own affective state - time pressures.
Be aware of our decision mode - establish accountability in a given situation: Who is doing what? Who is responsible for what?
Non judgemental attitude
