Midterm #1 Flashcards
Ethical Principles it involves
– Autonomy
– Beneficence
– Non-maleficence
– Justice
Models describing the Pt/Dr relationship
- Paternalistic model
- Informative model
- Interpretive model
- Deliberative model
Paternalistic model
–The guardian
–Principle = Dr = make (nearly) all decisions for a patient
–Assumptions = People = not always rational/mature. Experts know better about the needs of patients.
–Problems = Qualified doctors have good will.
Are the needs of patients objective? How can we be sure that doctors have good will?
–Concerns = Threats autonomy// Assumes Pt does not understand or like the plan
Informative model
– Competent technical expert
Principle = The doctor should provide all the relevant information for the patient to make a decision, and provide the selected intervention on this basis.
Assumptions = A fact/value division of labor yields the best medical result.
What is good for a patient depends on what his/her personal values.
Concerns = What if the patient is unconscious or incompetent?
What if the patient is making choices unacceptable by our ethical standards? Third party payers’ role
Interpretive model
–counselor or advisor
–Principle = The doctor should help the patient articulate his/her values through interpretation, and provide intervention which is truly desired.
–Assumptions = Patients have subconscious and inconsistent desires.
Their conscious decisions may not reflect their deepest values.
see his/her own desires/values more clearly, but not to criticize them.
–Concerns = What if the patient is unconscious or incompetent, incompetent, and making choices totally unacceptable by our ethical standards? Third party payers’ role
All that a doctor can do is to help the patient
Interpretive model
deliberative model
–friend or teacher
Principle = The doctor should help the patient to deliberate well through dialogue and discussion, and so develop values which are objective and truly worthy.
Assumptions = The objectivity of values.
The patient’s good life consists not in the satisfaction of desires, but maturity and rationality.
Problems = The difference between dialogue and persuasion The boundary between doctor and patient can blur
communication dynamics
words = 7%
tone of voice = 22%
body language = 55%
talking = 75% of the Dr/Pt relationship
empathy skills =
reflect
validate
respect
support
things that are NOT empathy =
1) sympathy = internalizing the pt emotions = lose obj.
2) identification = lose obj bcuz something in common
3) pity = insincere empathy = condescending, patronizing
duties under duress =
activities performes w/ pain or difficulty
under no apparent distress =
instances where reported limitations are not validated
patient specific functional scale (PSFS)
= ID 3 important activities and rate each on scale 0-10
What is caring?
- -Communicate effectively
- -Empathetic
- -Arrange to meet healthcare needs
- -Respectfulandnonjudgmental
empathetic skills =
- -Reflection/ give a name to the emotion
- -Validation
- -Respect
- -Support
bad message
- Sighing
- Crossed Arms/ Legs
- Head Tilt ***
- Eye Contact ***
- Leaning Away
- Tensing of Muscles
- Facial Expression
- Breathing Changes
- Squirming and Shifting
good message
- Eye contact consistent
- Forward lean
- Avoid fidgeting
- Avoid distracted looks
- Hands…where are they & what are they doing?
- Facial expressions of concern, understanding ***
- Nodding of head
Three key elements of patient compliance:
– expectancy that results can be achieved
– belief that actions will lead to desired outcome
– having attractive or valuable goals
most frequent patient dissatisfaction =
failure o adequate an explanation
Report of Findings
1) offer a creditable explanation
2) Explain how you’d like to approach treatment for their problem(s)
3) Outline specifics of the treatment plan
4) Prognosis (know the course of the disease)
enhancing patients compliance with treatment plan
- -tie symptoms and limitations to cause of problem
- -stress pt role in recovery
- -ID barriers to compliance
- -involve pt in addressing barriers
PARQ conference is required by Oregon law &…
CMS requirement (for Medicare and Medicaid patients)
when is risk so remote as to be not worth discussing…
If it is minor and rare, forget about it
- If it is minor and common‐ discuss it
- If it is major and common‐ discuss it
- If it is major and uncommon‐ discuss it
• If it is major and very rare‐ depends on what it is…
– CVA‐ yep. Very rare and yet discussed
– Death from lumbar manipulation? Nope.
when do you need a PARQ?
ant time there needs to be an informed consent decision about therapeutic/diagnosis procedure
PARQ Vs. ROF
- ROF > comprehensive > PARQ
- PARQ = what can go wrong > not what we’re going to do
- PARQ can be within a ROF or not
- PARQ is the minimum requirement before tx.
- PARQ must include opportunity for questions**
