P&L: Midsem

Question 1

Outline the SPIKES model for sharing difficult information

Answer 1

S: Setting up (appropriate environment)
P: Perception (what do they know?)
I: invitation (what do they want to know?)
K: Knowledge (close the gap between the previous two)
E: Empathy (allow emotions to arise however they will)
S: Strategy (here’s what we’re gonna do about it)

Question 2

What are some characteristics of good interprofessional practice?

Answer 2

• Understanding everybody’s scope of practice
• Mutual respect
• Clear communication (and perhaps the allocation of a leader)
• Good documentation (and everybody can access the documentation)

Question 3

What are some common behavioural responses that compromise interprofessional collaborative practice in acute settings

Answer 3

• Not understanding scope of practice
• No clearly defined leader
• No documentation/communication

Question 4

True or false: high quality documentation is the sole responsibilit of the assigned team leader in a multidisciplinary setting.

Answer 4

• true, but it’s not the whole picture.
• High quality documentation is the responsibility of all health professionals involved

Question 5

List six characteristics of high-quality healthcare documentation

Answer 5

1. Up to date
2. Relevant
3. Person-centred
4. Accurate
5. Complete
6. Accessible to all

(CARP AU)

Question 6

What is the name of the national digital health record of Australia? How might technology change the way we collect data for it (1 example)?

Answer 6

• My Health Record is Australia’s digital information system
• AI transcription of consultations is showing promising signs

Question 7

What kind of information should be documented in health records?

Answer 7

• Clinical events
• Principal/secondary diagnoses
• Interventions (with a clear link to underlying cause)

Question 8

What responsibilities does a new medical practitioner have during a transition of care? Why?

Answer 8

• Introduce yourself; take steps to overcome communication barriers
• Consider the concerns of carers/family
• Ask patient permission before doing anything

(This is to build rapport, maximise compliance, and help the patient to feel comfortable despite the uncertainty of a new practitioner)

Question 9

What are safety risks for older patients that arise when sharing critical information (such as breaking bad news clinical handover, or explaining infectious status)

Answer 9

• Increased delirium risk
• Increased risk of adverse effects
• Increased risk of functional decline

Question 10

What are safety risks for all patients during sharing of critical information?

Answer 10

• Poorer satisfaction
• Increased psychological morbidity
• More likely to choose aggressive treatments; may regret

Question 11

What are 3 aspects of closing a good meeting?

Answer 11

• Signpost end coming up
• Communicate plan, and confirm they can follow it
• Address any questions and concerns

Question 12

What are some aspects of shared decision making?

Answer 12

• Consider treatment options
• Consider what happens if we do nothing
• Redescribe values of treatment
• Tailor information to patient’s needs

Question 13

What is continuity of care?

Answer 13

The ability to provide consistent, seamless access to healthcare services, across practitioners, programs, and time.

Question 14

What are some aspects of the doctor’s role in promoting continuity of care?

Answer 14

• Taking full responsibility for conflict, which is otherwise a common barrier
• Good technique during transitions of care (answering Qs etc.)

Question 15

What are some challenges involved in addressing misunderstandings/conflict in the healthcare setting?

Answer 15

• Patients may express a wide range of emotions, even those disproportionate to circumstances
• In some instances, these emotions may not be socially acceptable/appropriate in the community
• They may also place practitioners in danger, decreasing their ability to focus on providing high-quality care

Question 16

What are some techniques to employ when a patient becomes physically aggressive?

Answer 16

• Retain some kind of exit route (perhaps multiple)
• Keep your distance from the patient
• Remain as calm as possible, in body language and tone of voice

Question 17

What are some techniques to manage patient disengagement? How can use of language aid in this?

Answer 17

• Personalise the care; get to the root of how these issues affect the patient’s life, and talk in terms of things they care about
• Enhance health literacy
• Addressing barriers (interpreter, speaking louder, making cultural adjustments)
• Terminology: Avoid jargon, reinforcing and clarifying points, positive framing

Question 18

What is motivational interviewing? How does it help improve outcomes? What are its principles?

Answer 18

• Evidence-based approach to behaviour change
• Shown to improve traditional advice giving in a significant majority of instances
• Helps to drive healthy lifestyle changes that lead to positive downstream outcomes

Principles: define discrepancy, empathy, don’t argue for change, support self-efficacy

Question 19

List some settings where motivational interviewing may be useful, as well as may not be useful.

Answer 19

Useful:
- Calm environments
- Behavioural change
- Addiction
- Chronic illness management
- Mental health issues

Not Useful:
- Acute situations (e.g. mental health crisis/health problems 2° to addiction)
- Cognitive impairment (lower ability to engage?)

Question 20

How does stigmatising language affect a patient’s ability to engage with medical advice

Answer 20

• When a patient seeks medical care, they are placing their trust in doctors, and taking an active step towards improving their own health. This is good.
• When we use stigmatising language, we risk making the patient feel uncomfortable, ashamed, angered, or otherwise discriminated against. This makes them less likely to perform these beneficial behaviours in the future.

Question 21

What are some circumstances under which a decision to withhold/withdraw life-sustaining treatment may be made?

Answer 21

• Patient with capacity decides they’d like it withdrawn
• Advanced care directive states that they’d like it withdrawn
• In some cases, a patient’s substitute decision maker may be able to make this decision also

Question 22

What are the four “_ Me” principles of communicating with patients with disability/mental illness

Answer 22

Plan with me: plan for any reasonable adjustments
Understand me: gauge the patient’s baseline
Communicate with me: talk/include patients in discussion of diagnosis/treatment
Act with me: help the patient become an active participant in their own health

Question 23

Why might a patient with cognitive impairment have difficulty relating to healthcare professionals in the context of care?

Answer 23

• Reasonable adjustments have not been made
• Baseline may not have been set (hard to gauge symptoms)
• Stigmatising language may be being used
• Use of jargon, going too fast etc.

Question 24

Broadly, what kind of decision can substitute decision makers make (i.e., when do they come into play)?

Answer 24

• No ACD requests
• No capactiy

Question 25

What should substitute decision makers keep in mind when deciding?

Answer 25

Act based on their judgement of what would have best aligned with the patient’s values and priorities.

Question 26

Give two examples where a substitute decision maker’s decision can be refused

Answer 26

1. SDM makes suggestion for treatment that is clinically futile
2. Patient has previously rejected this treatment

Question 27

What is stigmatising language?

Answer 27

Language that supports negative, harmful attitudes, leading to intentional or unintentional discrimination.