Holistic Approach to Assessment and Management

Question 1

What is the Family Medicine SOAP Assessment?

Answer 1

Subjective
Objective
A3
- biological
- psychological
- social
P4
- presenting complaint
- chronic issues
- health promotion
- safety net

Question 2

Components of social history?

Answer 2

1. a more holistic approach
2. a functional assessment
3. relationships at home
4. psychosocial events
5. occupational issues

Question 3

Importance of bio-psycho-social assessment?

Answer 3

The biological, the psychological and the social aspects of your patient’s condition all interact to influence his / her response to treatment and outcome

Question 4

A1 - biological assessment?

Answer 4

1. Medical complaint
2. Physical diseases
3. Physiological
4. Pathology

Question 5

A2 - psychological assessment?

Answer 5

1. Thoughts / Emotions / Behaviors
2. Fear / Avoidance beliefs
3. Coping methods
4. Attributions (how we explain causes of behavior or events)
5. Worries /anxieties

Question 6

A3 - social?

Answer 6

1. Home environment, family members
2. Water source, food insecurity
3. Work / school
4. Level of education
5. Distance traveled to get to the hospital

Question 7

P4 - Four Plans?

Answer 7

1. Presenting problem / current diagnosis
2. On-going health issues, chronic problems
3. Opportunistic health promotion
4. Follow up visit and Safety netting

Question 8

Safety netting?

Answer 8

1. What if your treatment doesn’t work? What should happen?
   - Communicate uncertainty: sometimes early in disease process we can’t say what’s wrong and you’ll need to come back for us to make the right diagnosis
2. What if the patient gets worse? (Red Flags!)
   - tell the patient what to watch for and what means he has to return immediately
3. Follow up of investigation results
   - who will see lab results? How can patient be sure the CXR is reviewed?
4. Make sure referrals happen
   - Is transport arranged? Will they reach the right consultant/ward?

Question 9

4 E’s for successful patient encounters?

Answer 9

1. Explore
   - What do you understand about your illness? Anything else we can address?
2. Educate
   - May I tell you a bit more about controlling your condition?
3. Empower
   - What will you do to maintain your health? What plan will work for you?
4. Enable
   - How will you see that your medications are working? When will you know to seek further care?

Question 10

Describe shared decision making?

Answer 10

Can the patient follow these instructions?
Does he have money to buy that medication?
What drug can we give him free from the hospital if not?
Is he able to return for follow up in a week or not for a month?
Does he want to go to Queens to see a consultant there?
Does he have means to do so?
Does he have time to go to radiology for a CXR today?
Does he feel the need to be admitted now?
- Let the patient decide with you what plan he can follow.

Question 11

Tools for a successfuls encounter?

Answer 11

1. 4 E’s
2. Repeat back / Summarize
   - What I think you have told me is your symptoms of “X” began “Y” weeks ago….. Do I have it right?
   - Avoid jargon
3. Use signposting
   “Unfortunately…,” “I am reassured that…”
4. Check for understanding
   - Can you tell me what you understood me to have just explained?
5. Questions?
   End every encounter with “do you have any questions?”