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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
Behaviour is influenced by
Attitudes - positive or negative Subjective norm Perceptions of control over behaviour
26
A person is more likely to make a behavioural change if
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
27
Stages of change
``` Pre-contemplation Contemplation Preparation Action Maintenance Relapse ```
28
Important factors in treating and communicating with patients with a disability
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
Factors of etiquette to consider
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
What principles of the Hippocratic Oath still apply?
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
What is the regulating body of doctor's behaviour?
GMC
32
What is autonomy?
Cornerstone of free society | People have the same rights to actions and choices as we ourselves would wish to have
33
When are individuals not autonomous?
Children | Individuals with severe learning disabilities
34
Limitations to autonomy
Acceptability of effects of individual actions on other people Applied through social pressure and the law of the land
35
Main features of professional relationship
Mutual respect and trust - based on empathy
36
What is empathy?
Ability to understand predicament of another and respect their autonomy without necessarily sympathising for them
37
Key components of the ethical code
Hippocratic oath Declaration of Geneva Physician's oath Constitution of the WHO
38
WHO definition of health
State of complete physical, mental and social well-being and not merely the absence of disease or infirmity
39
What percentage of people at any one time are attending their GP?
19%
40
What percentage of people at any one time are under hospital care?
3%
41
What percentage of people at any one time have symptoms and are taking action?
55%
42
What percentage of people at any one time have symptoms and are taking no action?
18%
43
What percentage of people at any one time have no symptoms?
3%
44
What is disease?
Symptoms, signs and diagnosis from a biomedical perspective
45
What is illness?
Ideas, concerns and expectation from a patient's perspective
46
Patient sources of referral information
``` Peers and family TV Health pages of newspapers and magazines "What should I do?" booklets SHOW website Practice leaflet or website ```
47
Examples of increasing role of community pharmacists
``` OTC contraception Statins Health checks Smoking cessation Minor ailments service ```
48
Factors affecting uptake of medical care
Medical | Non-medical
49
Medical factors affecting uptake of medical care
New symptoms Visible symptoms Increasing severity Duration
50
Non-medical factors affecting uptake of medical care
``` Crisis Peer pressure Patient beliefs Expectation Social class Economic Psychological Environmental Cultural Ethnic Age Gender ```
51
Definitions of illness
Acute Chronic Self-limiting
52
Factors affecting sick role
``` Social Familial Psychological Financial Medications Responsibilites ```
53
Features of sick role for the patient
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
Features of the sick role for the health care practitioner
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
Examples of people held responsible for illness
HIV | Lung cancer
56
Secondary gains from being classed as sick
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
Age and gender contact rates
Females attend GP and practice nurse appointments more than males Consultations increase as age increases
58
Advantages of house calls
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
Disadvantages of house calls
Lack of proper examination facilities No chaperone Time consuming Presence of relative may lead to lack of confidentiality
60
Doctors working in community
GPs Community child health specialists Community geriatric specialists Community family planning services
61
Ways to obtain direct access to services while bypassing GPs and NHS gatekeepers
``` NHS 24 and G-Med Family planning and GUM clinics Pharmacy minor ailment services Physiotherapy A&E Some parts of private sector ```
62
Illness presentations
Acute and severe illness | Minor illness
63
Doctor-patient relationship in hospital
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
GP doctor-patient relationship
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
Issues in having done majority of undergraduate training in hospital specialties
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
GP responsibilities
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
Conditions rare in GP
Appendicitis Cancer Acute MI
68
Conditions common in GP
``` 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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