NB2 18+19

Question 1

Rights and Responsibilities of the Physician
Once a Relationship is Formed?
how does a relationship start?

Answer 1

Bilateral contract: Patient requests assistance and physician agrees

physician duty is dependent on consent and contract

rights: 
informed consent 
non-abandonment
confidentiality 
standard of care

Question 2

informing the patient

Answer 2

Nature of the disorder
Available treatments (including recommendation)
Probable course if untreated

respect patient choices

Question 3

rights of the patient

Answer 3

patient’s bill of rights (1972):

get complete info
refuse treatment
right to know conflicts of interest

Patient Self-Determination Act (1991):

Patients must be given written information about their health care decision making rights and the institutional policy on advance directives

Question 4

doctor- patient communication

Answer 4

1. Create a good interpersonal relationship
2. Facilitate exchange of information
3. Include patients in decision making

overall goal is to build trust with the patient

Question 5

informed patients have better outcomes regarding?

Answer 5

greater ability to tolerate pain
faster recovery
enhanced psychological adjustment to illness
decreased hospital stay

Question 6

benefits of a good doctor-patient relationship

Answer 6

will help patient regulate emotions
better understanding of medical information
allows for better understanding of patient needs
patients are more likely to follow through with care and be satisfied with care

Question 7

less likely to be sued if

Answer 7

spend longer with the patient
make orienting comments
engage in active listening
laugh and be funny

Question 8

barriers to effective communication

Answer 8

1. transference 
patient experiences (+ or -) 

2. countertransference (+ or -)
3. objectification or dehumanization
4. defining the patient by their illness
5. sensory or cognitive impairment
6. language or cultural differences

Question 9

barriers to treatment adherence

Answer 9

poor relationship

complex treatment

symptoms resolve

financial and time concerns

fear, denial, regression

Question 10

improving treatment adherence

Answer 10

behavior intervention

check ins

higher med dose; shorter time

discuss fears

Question 11

sick role: rights and obligations

Answer 11

rights:
Exempt from normal social roles
Not responsible for his/her condition
To be taken care of

obligations:
Should try to get well in order to return to social role(s)
Should seek technically competent help and cooperate with the medical professional

Question 12

how to recognize sick role

Answer 12

Symptoms might not respond to treatment
Symptoms might extend beyond normal course
Evidence the patient does not want to return to societal role
Symptoms of mental illness

Question 13

Post-concussion Syndrome

Answer 13

set of symptoms after a concussion

symptoms persist past 3 months

Headaches, dizziness, noise sensitivity, problems with
concentration and memory, irritability, depression, anxiety

etiology is debated

Question 14

non-focusing open-ended skills

Answer 14

encourage patient to speak freely without interruption

silence, nonverbal gestures, continuers

Question 15

focused open ended skills

Answer 15

help the patient develop their narrative beyond opening statement

allow physician to re-focus the patient

reflection (echoing) (repeat a word/phrase)
open-ended questions (expend on a statement)
summarizing (recaps info)

Question 16

Closed-Ended Data Gathering Skills

Answer 16

these skills limit the patient

used to confirm or reboot info

should be used sparingly

Ex: yes/No

Question 17

emotion seeking skills

Answer 17

direct:
how did that make you feel

avoid judgement

indirect:
patient may not directly respond to how they feel
indirectly explore emotions without directly acknowledging it

Question 18

empathy skills

Answer 18

doctor needs to express empathy after finding out emotion; make the patient feel they are understood and cared for

1. naming (repeat the expressed emotion)
2. understanding (acknowledge emotion)
3. respect (show appreciation)
4. support (work together as a team to find a solution)

Question 19

stages of change model

Answer 19

1. pre-contemplative (not considering change)
2. contemplative (weighing pros and cons)
3. preparation (develop action plan; make change)
4. action (made modifications)
5. maintenance (able to resist temptation to return to pervious lifestyle)

Question 20

Motivational Interviewing

Answer 20

Motivational interviewing is a collaborative, person-centered conversation guiding patients towards change by eliciting and strengthening their motivation to change

1. Collaboration between the health care provider and patient
2. Compassion and non-judgement
3. Acceptance and respect for patient autonomy
4. Evocation: the best ideas come from the patient

Steps: OARS
O = open ended questions 
A = affirmations
R = reflection 
S = summarizing