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COPY BDS3 University of Adelaide Dentistry > Patient Centred Care > Flashcards

Patient Centred Care Flashcards

1
Q

What are the issues with a patient presenting to your surgery under the influence of alcohol?

A

Inability to consent properly to treatment

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2
Q

When is it inappropriate for a patient to drive home after treatment?

A

1) If medications that interfere with cognition have been administered (sedation/GA)
2) If a medical emergency has occurred (syncope, asthma attack, allergic reaction)
3) Patient’s cognition has been affected (eg alcohol/drugs)

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3
Q

Why would you give written instructions after treatment?

A

1) Patient might be able to fully comprehend your instructions straight after treatment (eg if sedation/GA given)
2) Patient has a record of instructions after the fact
3) Legal record of care

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4
Q

If a patient calls you on the weekend and you can’t provide care, what steps can you do?

A

1) Refer to another colleague in the practice
2) Advise when you will be able to see them at the next available appointment
3) Refer to a dentist on the ADA emergency after hours clinic list
4) Advise on interim steps to deal with the tooth, trauma and pain

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5
Q

What are 3 aspects of the risk management cycle?

A
  1. Awareness - where the risks exist
  2. Control - strategies to minimise incidence of risks
  3. Containment - limited the damage when things go wrong
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6
Q

Which part of the risk management cycle to dissatisfied patients belong?

A

Risk Containment

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7
Q

What are reasons for patient complaints?

A
  1. Acknowledgment of something going wrong- explanation for why it went wrong
  2. Apology for distress they experienced
  3. Don’t want others to experience the same problem
  4. Improve service for themselves/others in future
  5. Want to blame, punish, hold accountable individual/entity for what happened
  6. Want retreatment, refund or compensation
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8
Q

What 3 things are more likely to result in positive outcomes for patient complaints?

A
  1. Objective analysis of the circumstances
  2. Appropriate lessons are learnt
  3. Risk is reduced in the future
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9
Q

What are 6 avenues that patients can take with complaints?

A
  1. Confront dentist/staff directly
  2. Write to dentist
  3. Write to statutory authority (ACCC/APHRA)
  4. Legal Representative
  5. Complain to another dentist
  6. Don’t complain - but never come back!
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10
Q

After receiving the complaint, what are considerations before addressing the issue?

A
  1. Nature of Complaint (seriousness / complexity)
  2. Wishes of Complainant
  3. Issues raised
  4. How the complaint came to you
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11
Q

If the patient complains to the dentist or staff directly, what actions should be taken?

A
  1. Don’t ignore complaint
  2. Engage Eye Contact
  3. Listen, Don’t Judge, Don’t Interrupt
  4. Be Empathetic
  5. Make detailed record of interaction immediately after the event
  6. Seek advice (ADA/Practice Manager/Dental Insurer)
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12
Q

If the patient complains by writing directly to the dentist, what actions should be taken?

A
  1. Seek to do a written response
  2. Offer to discuss further
  3. If appropriate mention that they are still welcome to receive further care/service after the complaint
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13
Q

If the patient complains by writing to the statutory authority, what actions should be taken?

A
  1. Practice will receive notice and be asked to respond
  2. Seek ADA, Legal, Insurance advice before submitting
  3. Control all negative emotions
  4. Always show respect / attempt to assist: give a courteous reply
  5. Report should be done in descriptive narrative terms, be comprehensive and fair
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14
Q

If the patient complains by writing to your legal representative, what actions should be taken?

A

Do not respond until seeking assistance of ADA advisors, legal reps from insurers.

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15
Q

If a patient complains to you about work done by another dentist, how should respond

A
  1. Point out clinical problems without criticising work/others
  2. Don’t admit or agree that previous dentist has liability
  3. If considering replacing/repairing work: ask patient’s permission to contact previous dentist to research why things have gotten to that point
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16
Q

What are some strategies to ensure good outcomes with complaints?

A
  1. Give a timely response
  2. Address all areas of the complaint
  3. Don’t be defensive
  4. Deal with complaint directly where possible
  5. Acknowledge the distress in the complaint
  6. Say sorry - it’s not a admission of liability
  7. Be Sympathetic
  8. Acknowledge errors did occur
  9. Avoid Jargon
  10. Provide your perspective
  11. Seek Support (ADA, Insurer, other staff)
  12. Be aware of different views of health
  13. Have complaints handling mechanisms in place
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17
Q

What is Open Disclosure?

A

Open disclosure is the open discussion of adverse events that result in harm to a patient while receiving health care with the patient, their family and carers

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18
Q

What is Open Disclosure?

A

Open disclosure is the open discussion of adverse events that result in harm to a patient while receiving health care with the patient, their family and carers

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19
Q

What are 5 elements of Open Disclosure?

A
  1. Apology or expression of regret, which should include the words ‘I am sorry’ or ‘we are sorry’
  2. Factual explanation of what happened
  3. Opportunity for the patient, their family and carers to relate their experience
  4. Discussion of the potential consequences of the adverse event
  5. Explanation of the steps being taken to manage the adverse event and prevent recurrence.
20
Q

What are 5 elements of Open Disclosure?

A
  1. Apology or expression of regret, which should include the words ‘I am sorry’ or ‘we are sorry’
  2. Factual explanation of what happened
  3. Opportunity for the patient, their family and carers to relate their experience
  4. Discussion of the potential consequences of the adverse event
  5. Explanation of the steps being taken to manage the adverse event and prevent recurrence.
21
Q

What are 8 principles of Open Disclosure?

A
  1. Open and Timely Communication
  2. Acknowledgement
  3. Apology / Expression of Regret
  4. Supporting needs / expectations of patient
  5. Supporting needs / expectations of those providing care
  6. Integrated clinical risk management + systems improvement
  7. Good Governance
  8. Confidentiality
22
Q

What are the 6 elements of SA Health’s Open Disclosure Policy?

A 
Effective Incident Management
Open Disclosure processes
Health care Quality Improvement
Patient and Consumer Right
Legal Obligation
Core Health Professional Requirement (Code of conduct)
23
Q

After a patient incident, what 2 things need to happen?

A
  1. Open Disclosure

2. Incident Reporting

24
Q

Why is Open Disclosure important?

A
  1. , Aim with maintaining relationship - rapport / trust
  2. Improvement in process
  3. Clarifies Incident - mistake vs unforeseen consequence
  4. Helps with Closure for dentist
25
Q

How could you try to explain to a patient that you’ve exposed a pulp?

A

“I’ve finished the filling but unfortunately things hasn’t gone as we’ve planned. As we’ve drilled into the tooth, we’ve ended up exposing the dental pulp as we were trying to prepare the tooth to prevent the new filling from falling out”

26
Q

What things should be used in expressing regret?

A
  1. Statement of being sorry - sympathy
  2. Statement of recognition of patient’ feeling or impact of event - empathy
  3. Keep it simple
  4. No other statement needed for regret
  5. No need to include statement of liability, responsibility, error
  6. Pause after - to give patient space
  7. Say it with Sincerity
27
Q

What is passive voice and how can this be used when conveying bad news?

A

Passive voice is helpful Help when identifying the object (receiver) of the action is more important than the subject (agent). This help soften the statement and create concern around the patient.

Active Voice: The drill damaged the tooth

Passive Voice: The tooth was damaged by the drill

28
Q

If a patient returns to your practice and regrets having treatment in the first place, how can a dentist respond?

A
  1. Listen: let them vent, validate the concern and don’t be defensive
  2. See the patient’s POV: summarise and highlight the issue
  3. Acknowledge the facts of the complaint and the emotion
  4. Express regret, apologise
  5. Offer to help
29
Q

What are methods of communication apart from just patient and dentist dialogue in the chair?

A
  1. Providing written information

2. Ongoing communication: follow up phone call

30
Q

What are strategies to use in dealing with a patient that dissatisfied with his new denture?

A
  1. Acknowledge the problem
  2. Pinpoint the core reason for complaint
  3. Return to the agreed reason the dentist/patient agreed to pursue dentures
  4. Identify strategy to remedy strongest complaint
31
Q

What are possible reasons a patient is uncomfortable with their new denture

A 
Large Size
Feeling
Uncomfortable/Pain, New Occlusion
Too loose/tight
Abrasion causing Ulcers, Poor function with eating/speech
Altered taste
Poor oral hygiene
32
Q

How do you deal with a patient who is resistant to use Fluoride?

A
  1. Rolls with the conversation
  2. Doesn’t get combative
  3. Be very gentle
  4. Acknowledge true risks but in context: fluorosis
  5. Humbly ask patient to consider another perspective
33
Q

What are strategies to roll with resistance?

A
  1. Simple reflection Patient
  2. Amplified reflection
  3. Double-sided reflection
  4. Agreement with a twist
  5. Emphasizing personal choice and control
  6. Reframing
  7. Coming alongside/ siding with the negative
  8. Shift focus
34
Q

What is an example of a simple reflection patient interaction?

A

Patient “ I really don’t think I’m ready to make a change. ”
Clinician: “ You think that now is not a good time to make a change. ”

35
Q

What is an example of an amplified reflection interaction?

A

Patient: “Well, I really enjoy smoking, and frankly it just doesn’t seem to be causing me much of a problem right now.”

Clinician: “You’re not seeing any problems at all with your smoking.”

36
Q

What is an example of a double-sided reflection interaction?

A

Clinician: “On the one hand you feel that it will be really hard to change because of how much you enjoy candy, but on the other hand you recognize there would be a lot of benefits, not just for your teeth and gums but also for your weight. ”

37
Q

What is an example of an agreement with a twist interaction?

A

Clinician: “Well, you’re right, flossing can be time consuming and a hassle, but for most people so is dental treatment. It’s sort of a trade - off between flossing and dental treatment. ”

38
Q

What is an example of emphasizing personal choice and control interaction?

A

Clinician: “ I notice you’re a smoker and I’d like to talk to you about that if you would be willing. I promise I do not want to nag you or make you feel bad about being a smoker. The choice to smoke is completely up to you, but I would like to gain a better understanding of how you feel about your smoking. ”

39
Q

What is an example of a reframing interaction?

A

Clinician: “You feel like ice cream and candy is a way to treat yourself, but in the long run you are also treating yourself to a lot of pain and expense.”

40
Q

What is an example of coming alongside/ siding with the negative interaction?

A

Clinician: “ You see absolutely no way to make a change and no possible way that I could help. ”

41
Q

What is an example of a shift focus interaction?

A

Clinician: “ Well it sounds like you are quite doubtful about the information you have been provided and whether it really applies to you. Let’s switch gears and talk about the concerns that you do have.”

42
Q

What are the 4 motivational interviewing principles?

A
  1. Developing Discrepancy: Explore how current behaviour fits against current behaviour - what could be changed to achieve that goal
  2. Express Empathy: Understand where the patient is coming from
  3. Support Self-Efficacy and Optimism: confidence increase likelihood of change
  4. Roll with Resistance: Avoid arguing, don’t push back
43
Q

What are techniques used with motivational interviewing?

A

OARS

  1. Open Questions: helps to complete the picture
  2. Affirmations: strengthens rapport
  3. Reflective Listening - paraphasing what the patient says - helps validates that the patient is being listened to
  4. Summarising - end of session, summarise what the patient and you have discussed, to see if you’ve completely grasped the situation
44
Q

What are skills required in active listening

A
  1. Attentive Body Language (posture, gestures, appropriate eye contact, facial expressions, body movement)
  2. Following Skills (considered questions, attentive silence, using door openers)
  3. Reflecting Skills (paraphrasing, reflect back emotions/content, summarising)
45
Q

What are mistakes in active listening?

A
  1. Being judgemental: criticising, name calling, diagnosing
  2. Suggesting Solutions: ordering, threatening, moralising, excessive questioning, advising
  3. Avoiding Concerns: diverting, logical argument
46
Q

What are the 3 phases of breaking bad news?

A
  1. Preparation: patient is upright, good eye contact, adequate time, material available to help explain
  2. Discuss the news: what does the patient already know, what do they want to know, give information, respond to reaction
  3. Review situation: work out structured support mechanism

COPY BDS3 University of Adelaide Dentistry (28 decks)

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