Dr. Pt relationship II

Question 1

Name key dimension of a helpful doctor-pt relationship and potential obstacles

Answer 1

Obstacles: difference in perceived risks and benefits.

Helpful: when they perceive a high severity of illness. High susceptibility. Are capable of reducing risk, and confident the treatment will be successful. (think probability and benefit vs cost and probability of treatment)

Question 2

What are signs of non-cooperation in a pt?

Answer 2

lack of eye contact, little fight over rx/plans, withdrawn, fearful, depressed, manipulative, dependent.

Question 3

What should you do for a patient in a precontemplation state?

Answer 3

Build a relationship and express concern, but do not lecture. Validate their lack of readiness.

Question 4

What should you do for a patient in a contemplative state?

Answer 4

Explore ambivalence and praise them for their concern. Restates both sides. Look at barriers/benefits

Question 5

What should you do for a pt in the prep stage?

Answer 5

Encourage patient’s efforts and ask what difficulties he/she will face.

• encourage small changes
• Ask for a change date.

Question 6

What should you do for a pt in the Action stage?

Answer 6

Praise action and reinforce. Ask what else is nedded.

Question 7

What should you do for a pt in the maintenance stage?

Answer 7

• continue to re-enforce and support.
• Encourage internal rewards.
• Identify risks for relapse.

Question 8

What to do if relapse?

Answer 8

Reframe. (not failure, success for a while). New lessons.

Question 9

What are ways to facilitate patient engagement?

Answer 9

OARS:
-Open ended questions

• Affirming/recognizing the positives
• Reflection: framing to a more positive light (reframing) or acknowledging both sides of ambivalence (double sided reflection).
• Summarizing and pulling conversation together

Question 10

What are factors the likely influence pt success with change?

Answer 10

Patients are more likely to change if they feel that they are susceptible to a disease, and that if they were to be affected, they would lose a lot.
-Also, they are motivated to change if they feel they can be successful at treatment, and that the treatment would prevent the undesirable outcomes.

Question 11

What are the basic elements of motivational interviewing?

Answer 11

A method for encouraging patient collaboration to facilitate motivation for change. Have the pt reach conclusions on their own.

DOES NOT provide solutions until they make the decision to change.

Question 12

Principles of motivational interviewing

Answer 12

(DEARS):

• Develop Discrepancy
• Express Empathy
• Avoid argumentation
• Roll with Resistance
• Support self-efficacy