Patient-Physician Relationship Flashcards
describe the rights and responsibilities of the physician
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physician must inform the patient:
- the nature of the disorder
- available and recommended treatments
- probably course if untreated
- physician must listen to patients’ concerns, address them objectively and respect their decisions
- physicians may refuse to perform an act that conflicts with their moral or ethical principles but must respect the patient’s wishes and make appropriate referrals
describe the Patients Bill of Rights and the Patient Self-Determination Act
- Patients Bill of Rights
- right to receive complete info.
- right to refuse treatment
- right to know about a hospital’s financial conflicts of interest
- Patient Self-Determination Act
- established that patients must be given written info. about their health care decision making rights and the institutional policy on advance directives
what are the 3 main goals of doctor-patient communication?
- create a good interpersonal relationship
- facilitate exchange of information
- include patients in decision making
informed patients have a greater sense of control that has been associated with….
- greater ability to tolerate pain
- faster recovery from illness
- enhanced psychological adjustment to illness
- decreased length of hospital stay
what are benefits of good doctor-patient communication?
- helps regulate patients’ emotions
- facilitates comprehension of medical information
- allows for better identification of patients’ needs, perceptions and expectations
- patients are more likely to:
- be satisfied with their care
- share pertinent info.
- adhere to the treatment plan
- patients’ agreemenet with the doctor about the nature of the treatment and need for follow-up is strongly associated with their recovery
describe methods to improve communication with the patient
- open/receptive body language
- sit facing the patient
- maintain appropriate eye contact
- pleasant, encouraging tone
- empathy
- take time to understand their home life, socioeconomic situation, culture
- show interest, encouragement, warmth, courteousness and respect
tell adults _____ about diagnosis and prognosis
tell adults the complete truth about diagnosis and prognosis
speak to adult patients directly, not through _____
speak to adult patients directly, not through relatives or staff
do not discuss ______ with friends/family without the ______
do not discuss patient care with friends/family without the patients permission
do not offer premature reassurance, and do not order a course of action; provide info and let the patient decide
do not offer premature reassurance, and do not order a course of action; provide info and let the patient decide
describe barriers to effective communication between physician-patient
- transferance
- relationship schemas (beliefs, expectations, perceptions from the past affecting the present)
- female patient woulnd’t disclose all info to male patient in order to look a certain way
- countertransferance
- physician’s relationship schemas
- physician’s mother dies from cancer, and that makes it hard to give news about cancer to patient
describe objectification/dehumanization
- using the patient as a teaching tool in a teaching hospital in direct view of patient
- discussing with colleagues in listening range of the patient
describe methods to get around sensory impairment and cognitive impairment of the patient
- sensory impairment
- be prepared to utilize a sign language interpreter or written materials
- cognitive impairment
- provide written instructions for memory impaired patients
- determine patient competency to understand and comply with treatment recommendations, refer for eval if needed
describe patient barriers to treatment adherence
- fears
- loss of bodily integrity from medication side effects
- dependency on others
- loss of masculinity (playing through an injury)
- loss of work time, fear of losing their livelihood
- denial/avoidance
- refusal to admit being ill or to acknowledge severity
- regression
- reverting to immature, attention-seeking behaviors
descibe methods to improve treatment adherence
- medications
- discussion of patients fears and avoidance strategies
- higher doses, shorter treatment course
- assess adherence at every clinical encounter with check-ins between if needed
- pillbox simulations
- behavioral interventions
- enlist caregivers, family members
- diaries, logs, workbooks
describe why some patients like the sick role
- sick person is exempt from normal social roles
- not responsible for their condition
- with physician and social support, the patient must work towards a return to health
describe why the sick role is relevant
- symptoms might not respond to treatment
- symptoms might extend beyond their normal course
- “iatrogenic” symptoms
describe postcussional syndrome
- history of head trauma with loss of consciousness preceeding symptoms onset by max of 4 weeks
- patients hav ea pre-occupation with symptoms and adopt the sick role
what are predictors of prolonged recovery in poscussional patients, and what is the single best predictor?
- predictors
- initial symptoms of headache and loss of consciousness
- presenting with >4 symptoms
- number of prior concussions
- premorbid neurologic or psychiatric symptoms
- older age
- single best predictor = litigation
- some sort of secondary gain ($$, sick role)
describe SPIKES
6-step protocol for conveying bad news to patients
- Setting up the interview
- Perception of the patient
- Invitation
- Knowledge
- Emotions/empathy
- Strategy/summary
describe setting up the interview (SPIKES)
- arrange for privacy
- involve significant others at the patient’s request
- sit down and maintain eye contact
- touch the patient’s hand or arm (if appropriate)
- silence your pager and do not answer phone
describe perception of the patient (SPIKES)
- find out what the patient understands about the medical situation
- determine if the patient is using denial or wishful thinking
- determine if the patient has unrealistic expectations about the diagnosis
describe invitation (SPIKES)
- find out how the patient would like to receive the diagnosis and related info
- find out how much detail the patient wishes to have
- offer to answer questions in the future
- offer to talk to a relative or friend
describe knowledge (SPIKES)
- prepare the patient for bad news
- give the positive news first
- present bad news clearly and unambiguously
- give info in small doses and check their understanding
- use nontechnical words
- avoid conveying hopelessness
describe emotions/empathy (SPIKES)
- observe the patient’s emotions
- ask the patient about how the news makes them feel
- connect the emotion with the reason for it
- be able to sit with their distress and tolerate the discomfort
- stay near the patient and wait for them to speak
- ask if anyone should be called
describe strategy/summary (SPIKES)
- ask the patient if they are ready to discuss treatment
- evaluate the patient’s understanding, expectation, and hopes for the future
- share decision-making responsibility with the patient
- understand the goals of the patient (i.e. pain control)
- state immediate plans for care
- schedule a follow-up visit
describe communicating prognosis
- ask a patient in info about prognosis is desired before providing it
- balance between realism and compassion
- give averages and allow for outliers in both directions
- “the avg person with your illness will live 3-9 months. It could be longer if treatment is successful, but unfortunately, it could be shorter”
- “let’s hope for the best and prepare for the worst”
