Core Skills In Family Medicine Flashcards
RICE
- Reason
- Idea
- Concern
- Expectation
Assessment of presenting problem: 4P
- Predisposing factors
- Precipitating factors
- Perpetuating factors
- Protective factors
Assessment of mental health problem: BATHE technique
B: Background (“What is going on in your life?”)
A: Affect (“How does that make you feel?”)
T: Trouble (“What troubles you the most?”)
H: Handling (“How could you handle that?”)
E: Empathy (“That must be very difficult”)
Medical record: SOAP
-
Subjective
- Chief complaint
- History
- RICE -
Objective
- Positive + Negative signs
- Investigation results -
Assessment
- Diagnosis
- Bio-psycho-social problems
- DDx
- Impression -
Plan
- Management plan
- Prescription
- Follow up
Writing a prescription
- Drug name
- Preparation
- Dosage
- Route
- Frequency
- Duration
- Amount
Management: RAPRIOP
-
Reassurance & Explanation
- Counsel on diagnosis, pathophysiology, prognosis
- Correct misperceptions regarding condition / treatments
- Explain management plan
- Address concerns - Advice and counselling
- Prescribing
- Referral
- Investigation
- Observation & Follow-up
- Prevention
Non-drug intervention (NDI)
- Communication techniques to express empathy and alleviate distress
- Affirmation
- Reframing
- Normalization
- Acceptance - Psychoeducation (depression, panic/ anxiety, sleep)
- Knowledge transfer
- Promote understanding
- Support treatment
- Promote self-help - Relaxation techniques
- Slow breathing exercises
—> Breathe in slowly through your nose, then hold your breath for 3 seconds
—> Breath out slowly
—> Continue for 5 mins / until symptoms of over-breathing abates
- Guided imagery / meditation
- Progressive muscle relaxation
—> Start with 3mins of SBE and finish with 5mins of SBE
—> Moving through the different muscle groups in your body slowly clench then relax, concentrating on the different feelings in your muscles when you are tense and when you are relax
- Mindfulness-Based Stress Reduction (MBSR) -
Behavioural activation / Exercise
- emphasise planned activities which help to increase behaviours that are likely to produce improvements in thoughts, mood, and overall quality of life
—> increase pleasurable activities
—> enhance social interactions
—> promote better sleep
—> improve self-esteem - Guided CBT
Psychoeducation
Any educational intervention offered to individuals to empower them to improve their health
- Reduce stigma, self-blame, barriers to treatment
Goals:
1. Knowledge transfer (e.g. pathophysiology or the cause of the illness, education about treatments)
2. Promote understanding (e.g. to understand what can make things worse / better)
3. Support treatment (e.g. to enhance compliance)
4. Promote self-help (e.g. what to do if a crisis occurs)
Example:
- Refer patients to books / websites
- Provide patient education leaflets
Motivational Interview (MI)
-
Engaging
- Establishing a connection
- Exploring strengths, values & goals
- Key of engagement is “listening” -
Focusing
- What most important to you today?
- What you want to talk about today? -
Evoking
- Elicit client’s own motivation & resistance
- Allow ambivalent clients to argue for change -
Planning
- The bridge to change
- Strengthening commitment
- Involves negotiating (goals & plans)
- Implementing & adjusting
Communication strategies:
1. Opened-ended questions
2. Affirmation
3. Reflection
4. Summary
6 Steps approach to negotiating change
Change talk: DARN-CAT
Step 1: Building a partnership
Step 2: Negotiating an agenda
Step 3: Assessing resistance and motivation
Step 4: Enhancing mutual understanding
Step 5: Implementing a plan
Step 6: Following through
DARN-CAT:
- Desire: “I really want to…”
- Ability: “I’ve done it before”
- Reason: “I would have more energy if I lost weight”
- Need: “I can’t go through life like this, I have to…”
- Commitment: “I will make changes”
- Activation: “I’m ready, prepared, or willing to make changes”
- Taking steps: “I’m taking specific action to change”
Behavioural change skills + Stages of change
Behavioural change skills:
1. Assess patients’ stage
2. Provide advice
3. Establish contract
4. Assist with change
5. Agree on FU + maintenance
Stages of change:
1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination
Family life-cycle (From JC126)
***6 Stages:
1. Leaving home (i.e. single young adult)
2. Marriage (i.e. new couple)
3. Families with young children
4. Families with adolescents
5. Families launching children and moving on (empty-nest)
6. Families in later life
Satir’s model
- Blaming
- Placator (Peace-maker)
- Super-reasonable / Computing
- Irrelevant (Clown)
- Congruent (Self-actualised / Balanced)
Sleep hygiene
- Limiting daytime naps to 30 minutes
- Avoiding stimulants such as caffeine and nicotine close to bedtime
- Exercising to promote good quality sleep
- Steering clear of food that can be disruptive right before sleep
- Ensuring adequate exposure to natural light
- Establishing a regular relaxing bedtime routine
- Making sure that the sleep environment is pleasant
Approach to FU / Chronic patients
4C, 1L
1. Control
2. Compliance
3. Complication
4. Comorbidity
5. Lifestyle
