General Flashcards
Consultation Framework/Calgary-Cambridge Skills Guide stages
•Initiation •Gathering information •Structuring •Physical examination •Building the doctor-patient relationship •Explanation and planning •Closing
Gathering information-Biomedical perspective
WWQQAA=>Where; When, Quality; Quantity; Aggravating/Alleviating factors; Associated manifestations
Gathering information-Patient’s perspective
ICEEF=>Ideas and beliefs; Concerns; Expectations; Effects on daily living; Feelings
Problem solving according to personality types
S=>N=>T=>F
Facts=>Possibilities=>Logic=>People
Six Basic Emotions
Disgust, Happiness, Sadness, Anger, Fear, Surprise
Influences on the actions of the doctor
•Own knowledge/ideas/belief systems •Ideas/stances/traditions/preferences of the patient •What is best for the community as a whole •Norms and standards according to the HPCSA •Constitution/laws of the country •What is morally good
Models of Dr-Pt Interactions
- Paternalistic-One way, Dr tells Pt
- Informative-Dr supplies info, Pt has to choose
- Deliberative-Dr acts as counsellor to try and better behaviour/habits/understanding
- Interpretative-Shared responsibility, Dr facilitates consideration of all alternatives
Principles of professionalism
- Beneficence
- Non-maleficence
- (Respect for) Autonomy
- (Distributive) Justice
Responsibilities of the Dr
Use effective Hx and phys exam to reach Dx, psycho-educate, answer questions, advocate for the best (EBHC) Tx, motivate and support, informed consent, follow-up availability
Responsibilities of the Pt
Ask questions, make informed decisions, take ownership of illness, participate in Tx, esp change of lifestyle
Opportunities to take a spiritual history
- social crisis/time of loss
- at registration/during health check-up
- in the peri-operative period
- dying/suffering form terminal/major illness
Components of a spiritual history-taking
- Beliefs, incl what is important in life
- Practices, incl praying
- Support from ex faith community
Symptom-analysis to gain particulars/details about a leading symptom
SOCRATES
Site; Onset; Character; Radiation; Alleviating factors; Timing; Exacerbating factors; Severity/scale of intensity
Define Systems Review (SR)/Systemic Enquiry (SE)
A checklist to screen other systems of the body not covered by the MC for clinically relevant S+S
General; Eyes and ENT; CVS; Resp; GIT; Breasts and genitourinary system; NS; Musculoskeletal system
SR-General
fatigue, malaise, sleep disturbances
fever, rigors, night sweats
change in appetite/weight
skin-rashes and bruising
SR-Eyes and ENT
eyes-itch, redness, secretions, swelling, blurred vision
ears-itch, pain, discharge, tinnitus
nose-congested, runny, secretions-clear, yellow, green
throat-pain, hoarseness, difficulty swallowing
SR-CVS
chest pain, palpitations, ankle oedema
shortness of breath-activity, dressing, exercise
orthopnoea-SOB when lying flat
PND-paroxysmal nocturnal dyspnoea
SR-Respiratory system
pleuritic chest pain, wheezing
cough, shortness of breath
haemoptysis-sputum colour and quantity
SR-GIT system
abdominal pain-incl nature and region N+V-incl haematemesis dysphagia, indigestion, dyspepsia (heartburn) flatulence, belching change in appetite/weight change in bowel action, constipation diarrhoea-presence of blood/mucous
SR-Breasts and Genitourinary system
urgency and frequency of urination
dysuria, polyuria, oliguria, nocturia, haematuria
urinary incontinence
M-prostatic symptoms
F-menstruation-reg/irreg/during pregnancy, post-menopausal bleeding, vaginal discharge
SR-Nervous system
headaches, dizziness, fits, loss of memory
fainting, loss of consciousness
anxiety, depression, personality change
weakness, numbness, tingling sensations
SR-Musculoskeletal system
pain, swelling of limbs/joints
stiffness of joints/back muscles
able to wash, dress, climb stairs
Past medical history-Chronic illnesses
DEARTHHH and surgical procedures (type, time, place, complications)
Diabetes, Epilepsy, Asthma, Rheumatic fever, Thyroid, Hypertension, Heart disease, Hypercholesterolaemia (incl Dx, Tx and check-up)
Describe two methods of performing hand hygiene
- Hand rub with an alcohol-based formulation; preferred for routine hand hygiene if hands are not visibly soiled; fast, effective and better tolerated by hands.
- Wash with soap and water; when hands are visibly soiled or after contact with body fluids and after using the toilet; also preferred during outbreaks of Clostridium difficile.
