Comms/presc Flashcards
What does ICE stand for?
- ideas
- concerns
- expectations
What is system 1? (3)
- Automatic brain with information that is relevant
- no effort on our part
- easy associations
What is system 2? (3)
- conscious and full of effort
- learned
- tries to forget the system 1 idea
Why is ICE relevant?
- You need to ensure you address the concerns of the patient and what they were hoping to get from the appointment
What is beneficent paternalism? (2)
- Doctors acting on behalf, and for the good of, patients
- Can occasionally be without regard to patient’s own needs and interests
What is a doctors agenda likely to be?
- More interested in the patient and their presenting complain
What is a patient-centred agenda likely to be?
- More related to their hopes and beliefs
What can contribute to your “power” as a clinician? (4)
- Medical knowledge
- Contribute to work/social life
- have to be requested - approach
- language and tone
How does satisfaction relate to an appointment? (2)
- Evidence shows that satisfying patients helps them get better quicker
- more likely to adhere if they understand
What is medicalisation?
- process by which human problems come to be defined /treated as medical conditions
- become the subject of medical study, diagnosis, or treatment.
What is the rule of thirds?
- 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
What is the health-belief model? (3)
- 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
What is the internal controller? (2)
- believes that they’re in charge of their own future health
- like explanations and critical thinking
What is the external controller? (4)
- 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
What is the powerful other? (2)
- They believe YOU are in charge of their health
- Resist strategies to make them take control of their own health
What are the three types of loci?
- The internal controller
- The external controller
- The powerful other
What are frames of reference?
- The patients frame of reference is their health beliefs
- Yours is your knowledge and understanding
- rarely they’ll be the same
What is the clerking structure?
- Name/DoB
- Presenting complaint
- History of PC
- Past medical history
- Drug history/allergies
- Family history
- Social history
- Systematic review
What is the issue with clerking?
- It is autonomous
- Isn’t patient-based
What makes up the history?
- Verbal information
- Verbal cutes
- Non-verbal information
- Non-verbal cues
How can we structure questioning in consultations?
- Open questions - to establish facts to develop a hypothesis
- Closed questions - test hypotheses and sense check
What are negative symptoms?
- What do not occur but which can help exclude a diagnosis
What are red-flag symptoms?
- Can suggest a more serious underlying illness which needs early diagnosis and treatment
What is bounded rationality?
- Concept that we have limited information, intelligence and time to make that decision
What is the duel-process theory?
- Start as type 1 - something doesn’t fit. Override occurs so can become type 2
- We jump to conclusions
What is the conscious-competence cycle?
- Unconcious incompetence
- Concious incompetence
- Concious competence
- Unconcious competence
What is system 1 processing based on?
- Pattern recognition
- Based on experience
- Illness scripts, rules of thumb, short cuts
What is the framing effect?
- options decided if given as a positive or negative
What is anchoring bias?
- Early salient feature
- Brain latches onto something
What is conformation bias?
- Search for info supporting hypothesis - ignoring some information
What is availability bias?
- Easily recalled experience dominates evidence
What is sensory inattention?
- Focusing on one thing and cannot focus on something else
What is representation bias?
- Make judgements which are relied on representativeness
- Likely to judge wrongly
What is empathy?
- The ability to understand and share the feelings of another
What is essential to breaking bad news? (5)
- Honesty
- Meeting the patients need for information
- Don’t remove all hope
- Confidentiality
- Revisit the bad news
What are examples of three-way conversations?
- Parent and dependent child
- Child and elderly parent
- Partners
- Family translator
What are the considerations of parent and dependent child? (4)
- Gillick compentence
- Parental anxiety
- Engaging child
- Safeguarding
What are the considerations of child and elderly parent? (4)
- Adult safeguarding
- Child anxiety
- Engaging patient
- Confidentality
What are the considerations for partners? (4)
- Adult safeguarding
- confidentality
- Engaging patient
- Watching for “dominant other”
What are the considerations for family translator? (4)
- Confidentality
- Engaging patient
- Watch body language
- Safeguarding issues
What are the issues with translator consultations? (4)
- Loss of direct engagement
- Loss of verbal cues
- Harder to use humour or emotion
- Cultural challenges
Why are phone consultations difficult? (3)
- Only have history
- No visual cues
- Cannot examine the patient
What is the issue with angry patients? (2)
- They activate our system 1
- Automatic reaction is fright or flight
How can we manage angry patients?
- Explore the anger
- Apologise - not an admission of guilt
- Don’t accept aggression in the workplace
What can challenge shared decision making? (5)
- The “powerful other”
- Mental health
- problems with mental capacity
- young people
- patient rushed into a difficult decision
What is the Bolam test? (3)
- Act in accordance with a practice accepted as proper
- documentation is important
- amount of information offered is patient-specific
What is the Mental Capacity Act 2005? (3)
- When people have their mental capacity to make their own decisions
- Includes learning difficulties, illness, mental health
- situation and decision specific
What is stage 1 of deciding if under the Mental Capacity Act?
- Is there an impairment or disturbance of brain functions
What is stage 2 of deciding if under the Mental Capacity Act?
- If unable to do any 1 of: understand information, retain information to make decision, weigh up information and communicate it
What is metacognition?
- “thinking about thinking”
- stand back and observe own thinking
What is innumeracy?
- Inability to understand numbers
What is relative risk?
- Ratio of the probability of an event occuring in an exposed group to probability of the event occuring in a comparison, non-exposed group
What is absolute risk?
- The change in RISK of an outcome of a given treatment/activity compared to another treatment/activity
What is number needed to treat (NNT)?
- 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
What are barriers to risk-based decision making? (5)
- Incentives for prescribing
- Internal desire to “do” something
- Research pressures
- Cost pressures
- Patient perception
What issues does screening create?
- Anxiety
- Cost
- Unnecessary tests
What is prescribing?
Advice and authorisation of use of a medicine/treatment for someone
What are the types of drug presentations? (4)
- tablets
- capsules
- suspensions
- emulsions
What aids the decision of drug administration? (4)
- Appropriate delivery for issue
- drug type
- Varies by patient age, tolerability
- speed of action
What are Patient Group Directions (PGDs)?
- Documents permitting the supply of prescription-only medicines to groups of patients, without individual prescriptions
What are Patient Specific Directions (PSDs)?
- Written instruction, signed, for medicines to be supplied to a name patient after the prescriber has assessed the patient on an individual basis
What is an adverse events?
- negative consequence of care that results in unintended injury or illness that may or may not have been preventable
What are examples of adverse events?
- Wrong drug prescribed
- Wrong route of admission
- Incorrect instructions to patient
- Side effects, interactions, anaphylaxis
What is a national “Never Event”?
- 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
What are examples of national “Never Events”?
- Administration of strong potassium solution
- Overdose of insulin due to wrong device
- Selection of high strength midazolam during conscious sedation
What are some examples of patient barriers in prescribing? (6)
- Allergies (real/perceived)
- Personal beliefs - religious, cultural, vegan
- acceptability
- polypharmacy
- pre-conceptions
- stigma
What are some examples of clinician barriers in prescribing? (6)
- interactions
- pressure
- cost vs efficacy
- medicalisation “easy to do”
- demand for medication
- conformation bias
How can you build trust with your supervisor? (6)
- Regular communication
- Listening
- Show competence
- professionalism
- Create plans
- Know limitations, accept feedback
What is an audit?
- Methodical examination and review to a specific area of clinical care
What is Significant Event Analysis?
- analysing incidents that may have implications for patient care. - Learning from what went wrong or right should help improve your practice.
