Consultations Flashcards
Medical Consultation
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.
dental consultation
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
dental consultation 2
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
reasons for consultations
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
principles of medical consultation
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
Ethical principles of medical consulations
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
Types of consultations
dental professional to dental specialist - most common
general dentist to dental specialist
dental professional to medical professional
contents of the consultation request
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
glucose
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)
electrolytes
(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
waste products - BUN (blood urea nitrogen)
high values signify abnormal kidney function
creatinine
from muscle breakdown, may indicate problems w/ the kidneys
uric acid
normally excreted in urine. high values indicate gout, arthritis, kidney problems or diuretic use
enzymes
AST, ALT, SGOT, SGPT, GGT, alkaline phosphtase are all enzymes found in the blood that help w/ cellular chemical activities.
proteins
albumin and globulin measure the amt and type of protiein in the blood and are general index of overall health and nutrition
blood fats
LDL
HDL
Triglyceride
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
cbc (complete blood count)
values created by an automated cell counter.
high wbc - infection or leukemia
low wbc - HIV infection, bone marrow disease
RBC - hgb, hct and mcv
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
platelet count
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)
immune cells
(neutrophils, lymphocytes, monocytes, eosinophils, basophils) or the results of a disease state (e.g. AIDS, leukemia)
urinalysis
bilirubin
protein
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.
prothrombin time (PT)
evaluate adequacy of the extrinsic system and common pathway in the clotting mechanism
partial thromboplastin time (PTT)
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
bleeding time
measures speed in which small blood vessels close off to stop bleeding (the condition of the blood vessels) and platelet function
INR and dental treatment
INR does not require alteration of the therapy regimen unless the INR vlue is greater than 4.0
effective consults
address the questions at hand, provide a succinct but detailed history and advise the dentist to precautions and contraindications to treatment as needed
ineffective consults
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
The Last Clear Chance Doctrine
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
