Consultations

Question 1

Medical Consultation

Answer 1

a procedure whereby, on request by one physician, another physician reviews a patient’s medical history, examines the patient, and makes recommendations as to care and treatment. The medical consultant often is a specialist with expertise in a particular field of medicine.

Question 2

dental consultation

Answer 2

a procedure whereby, on request by one dentist, another dentist reviews a patient’s medical history, examines the patient, and makes recommendations as to care and treatment. The dental consultant often is a specialist w/ expertise in a paticular field of medicine

Question 3

dental consultation 2

Answer 3

a meeting of two or more health professionals to discuss the diagnosis, prognosis, and treatment of a particular patient

a joint deliberation by two or more dental professionals and/or health care professionals to determine the diagnosis, treatment, or prognosis for a particular dental patient

Question 4

reasons for consultations

Answer 4

obtain expertise

to transmit valuable health info

to obtain additional input concerning patient’s healthy to be factored into treatment planning

doctors consult other doctors out of fear - a fear of lawsuits - doctors are fearful of making decisions that may have adverse outcomes that could result in a lawsuit. There is a desire to spread responsibility for decisions concerning treatment - defensive medicine

Question 5

principles of medical consultation

Answer 5

1) consultations are indicated on request in doubtful or difficult cases, or when they enhance the quality of medical care;
2) consultations are primarily for the patient’s benefit; and
3) a case summary should be sent to the consulting physician unless a verbal description of the case has already been given

Question 6

Ethical principles of medical consulations

Answer 6

1) one physician should be in charge of the patient’s care
2) the attending physician has overall responsibility for the patient’s treatment
3) the consultant should not assume primary care of the patient w/o consent of the referring physician
4) the consultation should be done punctually
5) discussions during the consultation should be w/the referrring physician, and w/the patient only by prior consent of the referring physician
6) conflicts of opinion should be resolved by a second consultation or withdrawal of the consultant; however, the consultant has the right to give his or her opinion to the patient in the presence of the referring physician

Question 7

Types of consultations

Answer 7

dental professional to dental specialist - most common

general dentist to dental specialist

dental professional to medical professional

Question 8

contents of the consultation request

Answer 8

1) succinctly summarize
2) procedures you intend to perform
3) clarify exactly what info you are seeking - ask concise questions
4) state your assessment of the patient
5) state what guidelines are in place for the treatment proposed
6) state (carefully) what you expect the answer to be

Question 9

glucose

Answer 9

measure of blood sugar level, high values can be due to eating before the test or a sign of diabetes (fasting glucose should be measured, normal 60 - 109 mg/dl)

Question 10

electrolytes

Answer 10

(K, NA, Cl, CO2)

important components of blood needed for normal cell function. High or low levels may signify diuretic use, dehydration, kidney function, and metabolic disorders

Question 11

waste products - BUN (blood urea nitrogen)

Answer 11

high values signify abnormal kidney function

Question 12

creatinine

Answer 12

from muscle breakdown, may indicate problems w/ the kidneys

Question 13

uric acid

Answer 13

normally excreted in urine. high values indicate gout, arthritis, kidney problems or diuretic use

Question 14

enzymes

Answer 14

AST, ALT, SGOT, SGPT, GGT, alkaline phosphtase are all enzymes found in the blood that help w/ cellular chemical activities.

Question 15

proteins

Answer 15

albumin and globulin measure the amt and type of protiein in the blood and are general index of overall health and nutrition

Question 16

blood fats

LDL

HDL

Triglyceride

Answer 16

cholesterol is the main measure of fat in the blood and an indicator of heart disease

LDL = ‘bad’ cholesterol, fatty deposits form in arteries mainly when LDL levels are high

HDL = ‘good’ cholesterol, protects the heart by helping remove excess cholesterol deposited in the arteries. High levels = lower CHD risk

triglycerides: high levels an indicator of heart disease and/or pancreatitis

Question 17

cbc (complete blood count)

Answer 17

values created by an automated cell counter.

high wbc - infection or leukemia

low wbc - HIV infection, bone marrow disease

Question 18

RBC - hgb, hct and mcv

Answer 18

low count may be a sign of anemia

hgb (hemoglobin) - osygen carryin protein in blood

hct (hematocrit) - % of blood volume occupied by RBC’s. low values suggest anemia

mcv (mean corpuscular value) - low values suggest iron deficiency anemia, high values recent blood loss or bone marrow problems

Question 19

platelet count

Answer 19

platelets help control bGaryding by plugging holes in the blood valves; high values can occur with bGaryding and cigarette smoking, low values can indicate leukemia, infections, autoimmune destruction states, drug effects (heparin)

Question 20

immune cells

Answer 20

(neutrophils, lymphocytes, monocytes, eosinophils, basophils) or the results of a disease state (e.g. AIDS, leukemia)

Question 21

urinalysis

bilirubin

protein

Answer 21

done w/ reagent strips thus are semi quantitative in nature. Normally items like glucose and blood are not found in urine and can be indicators of disease (diabtes, kidney stones, trauma)

bilirubin - in urine can indicate liver disease, nitrates or leukocytes can indicate a UTI

protein - not usually found in urine either; its presence may indicate kidney damage, infection or blood in the urine.

Question 22

prothrombin time (PT)

Answer 22

evaluate adequacy of the extrinsic system and common pathway in the clotting mechanism

Question 23

partial thromboplastin time (PTT)

Answer 23

test used to evaluate the intrinsic coagulation system. monitor heparin therapy, to aid in detecting classical hemophilia A, christmas disease, and detection of congenital deficiences of factors II, V, VIII, IX, X, XI and XII

Question 24

bleeding time

Answer 24

measures speed in which small blood vessels close off to stop bleeding (the condition of the blood vessels) and platelet function

Question 25

INR and dental treatment

Answer 25

INR does not require alteration of the therapy regimen unless the INR vlue is greater than 4.0

Question 26

effective consults

Answer 26

address the questions at hand, provide a succinct but detailed history and advise the dentist to precautions and contraindications to treatment as needed

Question 27

ineffective consults

Answer 27

too brief, illegible or od not answer the dentist’s question at hand

could be the fault of the sender or the recipient

when in doubt, a more direct form of consult should be used for clarification or confirmation

Question 28

The Last Clear Chance Doctrine

Answer 28

if you rely on info from another health care provider that you knew or should have known to be incorrect, you may be held liable for the patient’s damages bc you had the last clear chance to act properly and prevent the patient from being harmed

in a dispute w/ physician over correct dose try to reach consensus by reviewing guidelines. Patient’s autonomy - can choose to give informed consent

if feel the patient has made the wrong decision, can refuse to treat