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Yr1 > Comms/presc > Flashcards

Comms/presc Flashcards

1
Q

What does ICE stand for?

A
  • ideas
  • concerns
  • expectations
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2
Q

What is system 1? (3)

A
  • Automatic brain with information that is relevant
  • no effort on our part
  • easy associations
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3
Q

What is system 2? (3)

A
  • conscious and full of effort
  • learned
  • tries to forget the system 1 idea
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4
Q

Why is ICE relevant?

A
  • You need to ensure you address the concerns of the patient and what they were hoping to get from the appointment
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5
Q

What is beneficent paternalism? (2)

A
  • Doctors acting on behalf, and for the good of, patients

- Can occasionally be without regard to patient’s own needs and interests

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6
Q

What is a doctors agenda likely to be?

A
  • More interested in the patient and their presenting complain
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7
Q

What is a patient-centred agenda likely to be?

A
  • More related to their hopes and beliefs
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8
Q

What can contribute to your “power” as a clinician? (4)

A
  • Medical knowledge
  • Contribute to work/social life
  • have to be requested - approach
  • language and tone
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9
Q

How does satisfaction relate to an appointment? (2)

A
  • Evidence shows that satisfying patients helps them get better quicker
  • more likely to adhere if they understand
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10
Q

What is medicalisation?

A
  • process by which human problems come to be defined /treated as medical conditions
  • become the subject of medical study, diagnosis, or treatment.
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11
Q

What is the rule of thirds?

A
  • 1/3 take advice and act so advice is effective
  • 1/3 take advice but not enough for it to be effective
  • 1/3 don’t bother
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12
Q

What is the health-belief model? (3)

A
  • peoples interest in their health and motivation to change it vary hugely
  • patients weigh up +ves and -ves of a course of action
  • these beliefs are not fixed
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13
Q

What is the internal controller? (2)

A
  • believes that they’re in charge of their own future health

- like explanations and critical thinking

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14
Q

What is the external controller? (4)

A
  • Do not believe they control their health
  • Told what to do to be rejected/accepted as they see fit
  • Not involved in decision making
  • Many have covert/overt mental health issues
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15
Q

What is the powerful other? (2)

A
  • They believe YOU are in charge of their health

- Resist strategies to make them take control of their own health

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16
Q

What are the three types of loci?

A
  • The internal controller
  • The external controller
  • The powerful other
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17
Q

What are frames of reference?

A
  • The patients frame of reference is their health beliefs
  • Yours is your knowledge and understanding
  • rarely they’ll be the same
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18
Q

What is the clerking structure?

A
  • Name/DoB
  • Presenting complaint
  • History of PC
  • Past medical history
  • Drug history/allergies
  • Family history
  • Social history
  • Systematic review
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19
Q

What is the issue with clerking?

A
  • It is autonomous

- Isn’t patient-based

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20
Q

What makes up the history?

A
  • Verbal information
  • Verbal cutes
  • Non-verbal information
  • Non-verbal cues
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21
Q

How can we structure questioning in consultations?

A
  • Open questions - to establish facts to develop a hypothesis
  • Closed questions - test hypotheses and sense check
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22
Q

What are negative symptoms?

A
  • What do not occur but which can help exclude a diagnosis
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23
Q

What are red-flag symptoms?

A
  • Can suggest a more serious underlying illness which needs early diagnosis and treatment
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24
Q

What is bounded rationality?

A
  • Concept that we have limited information, intelligence and time to make that decision
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25
Q

What is the duel-process theory?

A
  • Start as type 1 - something doesn’t fit. Override occurs so can become type 2
  • We jump to conclusions
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26
Q

What is the conscious-competence cycle?

A
  • Unconcious incompetence
  • Concious incompetence
  • Concious competence
  • Unconcious competence
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27
Q

What is system 1 processing based on?

A
  • Pattern recognition
  • Based on experience
  • Illness scripts, rules of thumb, short cuts
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28
Q

What is the framing effect?

A
  • options decided if given as a positive or negative
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29
Q

What is anchoring bias?

A
  • Early salient feature

- Brain latches onto something

30
Q

What is conformation bias?

A
  • Search for info supporting hypothesis - ignoring some information
31
Q

What is availability bias?

A
  • Easily recalled experience dominates evidence
32
Q

What is sensory inattention?

A
  • Focusing on one thing and cannot focus on something else
33
Q

What is representation bias?

A
  • Make judgements which are relied on representativeness

- Likely to judge wrongly

34
Q

What is empathy?

A
  • The ability to understand and share the feelings of another
35
Q

What is essential to breaking bad news? (5)

A
  • Honesty
  • Meeting the patients need for information
  • Don’t remove all hope
  • Confidentiality
  • Revisit the bad news
36
Q

What are examples of three-way conversations?

A
  • Parent and dependent child
  • Child and elderly parent
  • Partners
  • Family translator
37
Q

What are the considerations of parent and dependent child? (4)

A
  • Gillick compentence
  • Parental anxiety
  • Engaging child
  • Safeguarding
38
Q

What are the considerations of child and elderly parent? (4)

A
  • Adult safeguarding
  • Child anxiety
  • Engaging patient
  • Confidentality
39
Q

What are the considerations for partners? (4)

A
  • Adult safeguarding
  • confidentality
  • Engaging patient
  • Watching for “dominant other”
40
Q

What are the considerations for family translator? (4)

A
  • Confidentality
  • Engaging patient
  • Watch body language
  • Safeguarding issues
41
Q

What are the issues with translator consultations? (4)

A
  • Loss of direct engagement
  • Loss of verbal cues
  • Harder to use humour or emotion
  • Cultural challenges
42
Q

Why are phone consultations difficult? (3)

A
  • Only have history
  • No visual cues
  • Cannot examine the patient
43
Q

What is the issue with angry patients? (2)

A
  • They activate our system 1

- Automatic reaction is fright or flight

44
Q

How can we manage angry patients?

A
  • Explore the anger
  • Apologise - not an admission of guilt
  • Don’t accept aggression in the workplace
45
Q

What can challenge shared decision making? (5)

A
  • The “powerful other”
  • Mental health
  • problems with mental capacity
  • young people
  • patient rushed into a difficult decision
46
Q

What is the Bolam test? (3)

A
  • Act in accordance with a practice accepted as proper
  • documentation is important
  • amount of information offered is patient-specific
47
Q

What is the Mental Capacity Act 2005? (3)

A
  • When people have their mental capacity to make their own decisions
  • Includes learning difficulties, illness, mental health
  • situation and decision specific
48
Q

What is stage 1 of deciding if under the Mental Capacity Act?

A
  • Is there an impairment or disturbance of brain functions
49
Q

What is stage 2 of deciding if under the Mental Capacity Act?

A
  • If unable to do any 1 of: understand information, retain information to make decision, weigh up information and communicate it
50
Q

What is metacognition?

A
  • “thinking about thinking”

- stand back and observe own thinking

51
Q

What is innumeracy?

A
  • Inability to understand numbers
52
Q

What is relative risk?

A
  • Ratio of the probability of an event occuring in an exposed group to probability of the event occuring in a comparison, non-exposed group
53
Q

What is absolute risk?

A
  • The change in RISK of an outcome of a given treatment/activity compared to another treatment/activity
54
Q

What is number needed to treat (NNT)?

A
  • The average NUMBER of patients who need to be TREATED to prevent one additional bad outcome
  • defined as the inverse of the absolute risk reduction
55
Q

What are barriers to risk-based decision making? (5)

A
  • Incentives for prescribing
  • Internal desire to “do” something
  • Research pressures
  • Cost pressures
  • Patient perception
56
Q

What issues does screening create?

A
  • Anxiety
  • Cost
  • Unnecessary tests
57
Q

What is prescribing?

A

Advice and authorisation of use of a medicine/treatment for someone

58
Q

What are the types of drug presentations? (4)

A
  • tablets
  • capsules
  • suspensions
  • emulsions
59
Q

What aids the decision of drug administration? (4)

A
  • Appropriate delivery for issue
  • drug type
  • Varies by patient age, tolerability
  • speed of action
60
Q

What are Patient Group Directions (PGDs)?

A
  • Documents permitting the supply of prescription-only medicines to groups of patients, without individual prescriptions
61
Q

What are Patient Specific Directions (PSDs)?

A
  • Written instruction, signed, for medicines to be supplied to a name patient after the prescriber has assessed the patient on an individual basis
62
Q

What is an adverse events?

A
  • negative consequence of care that results in unintended injury or illness that may or may not have been preventable
63
Q

What are examples of adverse events?

A
  • Wrong drug prescribed
  • Wrong route of admission
  • Incorrect instructions to patient
  • Side effects, interactions, anaphylaxis
64
Q

What is a national “Never Event”?

A
  • Serious Incidents that are wholly preventable because guidance or safety recommendations are available at a national level and should have been implemented by all healthcare providers
65
Q

What are examples of national “Never Events”?

A
  • Administration of strong potassium solution
  • Overdose of insulin due to wrong device
  • Selection of high strength midazolam during conscious sedation
66
Q

What are some examples of patient barriers in prescribing? (6)

A
  • Allergies (real/perceived)
  • Personal beliefs - religious, cultural, vegan
  • acceptability
  • polypharmacy
  • pre-conceptions
  • stigma
67
Q

What are some examples of clinician barriers in prescribing? (6)

A
  • interactions
  • pressure
  • cost vs efficacy
  • medicalisation “easy to do”
  • demand for medication
  • conformation bias
68
Q

How can you build trust with your supervisor? (6)

A
  • Regular communication
  • Listening
  • Show competence
  • professionalism
  • Create plans
  • Know limitations, accept feedback
69
Q

What is an audit?

A
  • Methodical examination and review to a specific area of clinical care
70
Q

What is Significant Event Analysis?

A
  • analysing incidents that may have implications for patient care. - Learning from what went wrong or right should help improve your practice.

Yr1 (13 decks)

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