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FoPC Year 2 > Patient Centred Communication > Flashcards

Patient Centred Communication Flashcards

1
Q

How many consultations will a doctor do in a professional lifetime?

A

200,000

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2
Q

Communications problems lead to

A

complaints and claims

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3
Q

Communication improves

A 
Patient satisfaction 
Recall
Understanding 
Concordance 
Outcomes of care
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4
Q

Factors affecting clinical competence

A

Knowledge
Examination
Problem solving
Communication

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5
Q

Interviewing skills

A

Content skills
Perceptual skills
Process skills

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6
Q

Factors of content skills

A

What doctors communicate
Substance to their questions and responses
Information gathered and given
Responses

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7
Q

Factors of perceptual skills

A

What they are thinking and feeling
Internal decision making
Clinical reasoning
Awareness of own biases, attitudes and distractions

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8
Q

Factors of process skills

A

How they communicate
Way they communicate with the patients
How they discover the history or provide information
Verbal and non-verbal skills
How they structure and organise communication

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9
Q

Factors influencing consultation

A

Physical factors

Personal factors

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10
Q

Physical factors affecting consultation

A

Site and environment
Adequacy of medical records
Time constraints
Patient status

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11
Q

Personal factors affecting consultation

A 
Age
Sex 
Background and origins 
Knowledge and skills 
Beliefs 
Illness
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12
Q

Beliefs can be influenced by

A

Medical training (doctors only)
Media
Other people
Past experience

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13
Q

Styles of doctor-patient relationships

A

Authoritarian/paternalistic
Guidance/co-operation
Mutual partnership

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14
Q

Authoritarian/paternalistic doctor-patient relationship

A

Doctor uses all authority inherent in status
Resides in expertise and skills
Patient feels no autonomy, tries hard to please doctor and does not actively participate in treatment

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15
Q

Guidance/co-operation doctor-patient relationship

A

Doctor still exercises authority

Patient is obedient, has a greater feeling of autonomy and participates more actively in the relationship

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16
Q

Mutual partnership doctor-patient relationship

A

Appropriate moderation of use of doctors authority
Widest range of relevant diagnostic information emerges
Most successful treatment outcomes
Patient has some responsibility for successful outcome, involved in active participation and has greater feeling of autonomy

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17
Q

Interviewing techniques

A 
Open-ended questions 
Listening and silence 
Facilitation 
Different question types 
Confrontation 
Support and reassurance
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18
Q

Different types of question

A 
Open-ended 
Direct 
Closed 
Leading 
Reflected
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19
Q

When might confrontation be used?

A

When the doctor senses the patient is not speaking clearly or freely

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20
Q

What percentage of communication is verbal, tone of voice and non-verbal?

A

7% verbal
38% tone of voice
55% non-verbal

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21
Q

Types of non-verbal communication

A

Instinctive
Learned from life experiences
Learned from training
Clinical observation

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22
Q

Factors to be considered when interpreting body language

A

Culture
Context
Gesture clusters
Congruence

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23
Q

What is congruence?

A

The word used to describe when a patients body language matches their verbal language

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24
Q

Examples of body language

A

Gaze behaviour
Posture
Specific gestures

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25
Q

Behaviour is influenced by

A

Attitudes - positive or negative
Subjective norm
Perceptions of control over behaviour

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26
Q

A person is more likely to make a behavioural change if

A

Positive attitudes towards it
The change brings about consequences important to the patient
They believe others think it is important that they do it
They feel they have the necessary resources, skills or opportunities to overcome barriers

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27
Q

Stages of change

A 
Pre-contemplation 
Contemplation 
Preparation 
Action 
Maintenance 
Relapse
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28
Q

Important factors in treating and communicating with patients with a disability

A

Etiquette
Patient-centred approach
Think what can be done to achieve the best possible function
Diagnosis and assessment of disability
Work with multidisciplinary team, voluntary services and social work

29
Q

Factors of etiquette to consider

A

Don’t give assistance before first asking if the patient wants it
Don’t be upset if assistance is refused
Don’t be afraid to use figures of speech which refer to the impairment
Don’t use disabled as a noun
Don’t use nouns ending in ‘ic’ e.g. epileptic, diabetic

30
Q

What principles of the Hippocratic Oath still apply?

A

Duty to respect autonomy of individuals
Duty to do no harm and to do good towards the patient
Duty to ensure your expertise is justly distributed amongst all patients in your care

31
Q

What is the regulating body of doctor’s behaviour?

A

GMC

32
Q

What is autonomy?

A

Cornerstone of free society

People have the same rights to actions and choices as we ourselves would wish to have

33
Q

When are individuals not autonomous?

A

Children

Individuals with severe learning disabilities

34
Q

Limitations to autonomy

A

Acceptability of effects of individual actions on other people
Applied through social pressure and the law of the land

35
Q

Main features of professional relationship

A

Mutual respect and trust - based on empathy

36
Q

What is empathy?

A

Ability to understand predicament of another and respect their autonomy without necessarily sympathising for them

37
Q

Key components of the ethical code

A

Hippocratic oath
Declaration of Geneva Physician’s oath
Constitution of the WHO

38
Q

WHO definition of health

A

State of complete physical, mental and social well-being and not merely the absence of disease or infirmity

39
Q

What percentage of people at any one time are attending their GP?

A

19%

40
Q

What percentage of people at any one time are under hospital care?

A

3%

41
Q

What percentage of people at any one time have symptoms and are taking action?

A

55%

42
Q

What percentage of people at any one time have symptoms and are taking no action?

A

18%

43
Q

What percentage of people at any one time have no symptoms?

A

3%

44
Q

What is disease?

A

Symptoms, signs and diagnosis from a biomedical perspective

45
Q

What is illness?

A

Ideas, concerns and expectation from a patient’s perspective

46
Q

Patient sources of referral information

A 
Peers and family 
TV 
Health pages of newspapers and magazines 
"What should I do?" booklets 
SHOW website 
Practice leaflet or website
47
Q

Examples of increasing role of community pharmacists

A 
OTC contraception 
Statins 
Health checks 
Smoking cessation 
Minor ailments service
48
Q

Factors affecting uptake of medical care

A

Medical

Non-medical

49
Q

Medical factors affecting uptake of medical care

A

New symptoms
Visible symptoms
Increasing severity
Duration

50
Q

Non-medical factors affecting uptake of medical care

A 
Crisis 
Peer pressure 
Patient beliefs 
Expectation 
Social class 
Economic 
Psychological 
Environmental 
Cultural 
Ethnic 
Age 
Gender
51
Q

Definitions of illness

A

Acute
Chronic
Self-limiting

52
Q

Factors affecting sick role

A 
Social 
Familial 
Psychological 
Financial 
Medications 
Responsibilites
53
Q

Features of sick role for the patient

A

Patient is exempt from daily responsibilities, not responsible for being ill and unable to get better without help of a health care practitioner. Patient must seek help from HCP. Patient is under social obligation to get better as soon as possible to be able to take up social responsibilities again.

54
Q

Features of the sick role for the health care practitioner

A

Must be objective and not judge the patient morally. Must not act out of self-interest or greed but put patient’s best interest first. Must obey professional role of practice. Have to maintain necessary knowledge and skills to treat patients
Have the right to examine patient intimately, prescribe treatment and has wide autonomy in practice

55
Q

Examples of people held responsible for illness

A

HIV

Lung cancer

56
Q

Secondary gains from being classed as sick

A

Care and sympathy
Concern from family and friends
Financial allowances associated with disability
Using apparently disabling illness as explanation for failures
Avoiding work
Restoring status or domination in family
Achieving revenge for bad treatment or pay from employer or insurance company

57
Q

Age and gender contact rates

A

Females attend GP and practice nurse appointments more than males
Consultations increase as age increases

58
Q

Advantages of house calls

A

Useful information on patient’s ability to cope with chronic condition or disability
Useful information obtained from relative or carer
Provides social contact for the socially isolated

59
Q

Disadvantages of house calls

A

Lack of proper examination facilities
No chaperone
Time consuming
Presence of relative may lead to lack of confidentiality

60
Q

Doctors working in community

A

GPs
Community child health specialists
Community geriatric specialists
Community family planning services

61
Q

Ways to obtain direct access to services while bypassing GPs and NHS gatekeepers

A 
NHS 24 and G-Med 
Family planning and GUM clinics 
Pharmacy minor ailment services 
Physiotherapy 
A&E 
Some parts of private sector
62
Q

Illness presentations

A

Acute and severe illness

Minor illness

63
Q

Doctor-patient relationship in hospital

A

Hospital doctor deals with the individual patient for short periods of time for a specific purpose, decide if the specialty can offer the patient anything and matches patients needs to expertise and does whatever possible

64
Q

GP doctor-patient relationship

A

Patient’s medical advisor until patient death or GP retirement. Complex role, continuing and personal. Deal with many patients whose illness is difficult to diagnose in diagnostic/medical science terms.

65
Q

Issues in having done majority of undergraduate training in hospital specialties

A

Hospital is tip of the iceberg of care

Narrow spectrum of presentations seen in hospital and may gain distorted view of presentation of illnesses

66
Q

GP responsibilities

A

All individuals must register with GP practice to obtain benefits of NHS
GP is responsible for arranging provision of necessary healthcare for an individual
GP acts as patients representative/advocate
GP has responsibility for care of individuals and for general health and well-being of defined population of registered individuals, most of whom at any given point are healthy

67
Q

Conditions rare in GP

A

Appendicitis
Cancer
Acute MI

68
Q

Conditions common in GP

A 
Acute infections 
Skin disorders 
Psycho-emotional complaints 
Minor accidents 
Intestinal complaints
Rheumatic complaints
Symptomatic illnesses of uncertain origin 
Established chronic complaints

FoPC Year 2 (5 decks)

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