Midunderstandings Or Disagreements In Patient Care Flashcards
You’re a medical student on a ward and a patient has been prescribed a painkiller but mistakes it for another drug with a similar name that they have had a difficult experience with in the past. Patient is becoming increasingly more irritable.
How appropriate is the following:
(1) it’s your choice whether you take your medication
(2) can you calm down please your disturbing my other patients
(3) would you like to speak another doctor
(1) it’s your choice whether you take your medication - is appropriate but not ideal as whilst it does assure the patient they are not going to be folded to take a medication that they do not agree with, it is tone deaf and doesn’t actually address their concerns.
(2) can you calm down you may be disturbing my other patients, it is rude and dismissive and doesn’t actually take the concerns or the confusion of the patient into account. People rarely calm down when they are told to and so it is infuriating to tell a patient who just wants the best care to calm down.
(3) would you like to speak to a doctor - is is VERY APPROPRIATE as it takes into account the concerns of the patient and addresses the fact that you might not necessarily have the experience to deal with situation properly.
Patient has concerns about the hospital infection rates (would apply to other logistical aspects of the hospital) - they mention a news article that you haven’t read.
How appropriate is the following:
(1) offer to find out more about the infection rates before you begin the procedure
(2) offer to find out more about the infection rates but after you finish the procedure
(1) inappropriate but not awful because it isn’t in your scope of knowledge and so whilst gaining this information may act to reassure the patient it isn’t the time, it would be more appropriate to ask someone that would have the data on hand if they could assist after the procedure has taken place.
(2) offer to find out more about the infection rates but after you finish the procedure - is very appropriate as it offers reassurance but after the procedure has taken place.
A doctor feels as if a nurse isn’t contributing enough to the care of a patient. They often turn up late and their notes on the patient are not comprehensive.
How appropriate is the following:
(1) tell the nurse that you are going to raise this issue formally
(1) tell the nurse that you are going to raise this issue formally - is inappropriate but not awful as it doesn’t make an effort to solve the issue internally and instead it is indicative of a lack of communication within the healthcare team. If you were to report the issue without trying to solve the issue internally then the professional relationship between you and the nurse would surely erode.
It’s 6pm on a Friday and the labs are closed when you (a junior doctor) notice that a clotting test wasn’t carried out and a patient who is to undergo a surgical procedure on the following Monday. This lab is mandatory.
How appropriate is the following:
(1) immediately call the patient and explain the situation
(1) immediately call the patient and explain what as happened - is VERY INAPPROPRIATE as since you are a junior doctor it is not your place to make autonomous decisions about major aspects of patient care, it would be more appropriate to contact a senior colleague to assist in the situation.
Patient has been missing treatment/ tests that are very important because they do not see the worth in it/ do not see it as important
How appropriate is the following
(1) ask a senior colleague to explain the importance of the tests
(1) ask a senior colleague to explain the importance of the tests - very appropriate as it recognises that you are not qualified nor experienced enough to explain properly the importance of the tests and ensures that the proper information reaches the patient. A senior colleague will also likely induce a feeling of authority and so maybe increase the likelihood of the patient taking what has been said to heart.
Patient is being given NON INVASIVE TREATMENT in order to avoid INVASIVE TREATMENT being sorted to
How important is the following
(1) reassure the patient that doctors will take good care of care of them
(1) reassure the patient that doctors will take good care of care of them - reassuring is always a GREEN LIGHT if a patient appears to be confused and unsettled about the treatment, it is always a very appropriate first course of action
Patient is going to have INVASIVE AND/OR STRESSFUL TREATMENT and is visibly anxious or upset.
How important are the following:
(1) there may be other issues worrying/ concerning the patient
(1) there may be other issues worrying/ concerning the patient - is very important as if there other reasons that concern the patient this should be immediately addressed and resolved as quickly as possible in order to avoid further stressing the patient
Patient mentions they have been recommended medication but expresses concern, you’re a medical student and are not familiar with the medication mentioned
How appropriate are the following:
(1) suggest that the patient find a new medication
(1) suggest that the patient find a new medication, this is ALWAYS INAPPROPRIATE as it is never the patient RESPONSIBILITY to find or source medication or treatment this should be carried by trained and educated medical professionals
Patient will not benefit from additional care due to terminal or chronic illness but they have read articles suggesting that additional care would be beneficial.
How important is the following:
(1) maintaining a positive outlook on the patient’s case
(1) maintaining a positive outlook on the patient’s case - is important as it is always for a doctor to look on a patient’s case with optimism and read into the articles read by the patient on how additional treatment would be beneficial
Medical student is doing ward rounds with a senior doctor, the patient they consult with are to receive medication A but the medical student notices that the doctor writes down the patient will receive medication B - this could cause confusion in the patient and they could become distressed with a different medication being prescribe.
How appropriate are the following:
(1) confirm with the doctor what medication she wants to prescribe
(2) after the ward round ask another doctor what medication they would prescribe for this case
(1) confirm with the doctor what medication she wants to prescribe - very appropriate as it opens a line of dialogue and allows the doctor to explain why they changed the medication - fostered academic development in the student in their clinical journey
(2) after the ward round ask another doctor what medication they would prescribe for this case - this is inappropriate but not awful as it introduces unnecessary delay into the course of action of the student and the opinions of the doctor could vary from the doctor that the student did ward rounds with.
