PMHP Flashcards
Smoking cessation (6 mins)
~ Ask
- Do you smoke?
- what do you smoke?
- how long
- how many cigs a day
- why do you smoke
- Does anyone in the family smoke?
- Any children in the house?
~ Advise
- Smoking is harmful for your general health (CVS and Resp)
- Smoking is harmful for your oral health ( tooth loss , pigmentation, staining , periodontal disease , oral cancer , keratosis , lichen planus , delayed healing , red and white patches, dry mouth, bad breath)
- IT is expensive
~ Assess
- Are you interested in quitting
- What is your motivation to quit
- Have you tried quitting in the past?
- Why were you not successful and what worked
~ Assist
- Would you like any help from the local stop smoking services?
- These increase liklihood of quitting by 4 times
- NRT - evidence based that it helps quitting
- E-cigs ; new to the market so not all side effects are known as there isn’t enough research on them but still have some respiratory effects but significantly less harmful than tobacco
~ Refer
- Local cessation services - pharmacy/GP / smokeline
- Self referral through 0800848484
- It is run by NHS24 and staffed by trained advisors
- Offer written material
- Arrange followup within first week
Breaking bad news (6mins)
SCC - give results of biopsy confirming oral cancer
~ Setting
- ask what they expect from appointment
- sit down as same level as them
- Did they bring someone with them?
- how have they been since you last saw them ?
~ Perception
“ are you aware of what we’re here to discuss today?”
“ do you know what is the purpose of your biopsy was?”
“ Could you explain to me your understanding of things up until now?
~ Information
- inform the patient that you have the result of the biopsy
- ask them if they would you like to go through the findings
~ Knowledge
- “ I wish i had better news’ - warn them then give them few seconds before you continue
- Give them the knowledge of what you know ;
“ the test we have done has shown some abnormalities in the cells , I am afraid to say that you have mouth cancer”
- Give them a chance to ask any questions
~ Empathy
- I am deeply sorry to break this to you
- I understand that you must have loads of Qs , anything that comes to your mind?
- Pehaps you would want to bring your husband with you?
~ Summary and close
- Repeat news
- “The good newd in all of this is that we have acted quickly and will be able to move forward with treatment as soon as possile”
- I will be speaking to the surgeons today and they’ll be seeing you in the coming week to discuss treatment
- Prompt for Qs
- Give emergency contact and arrange a followup
SPIKES
What are the risk factors for oral cancer?
- Tobacco use
- Alcohol
- HPV-16
- Previous cancer
- Family history of SCC
- Sun exposure
- Poor diet
- Malnourished
- Immunocompromised
- Lichen planus
- Poor OH
Complaints procedure (12 minutes)
Patient is annoyed they had to wait an hour and receptionist was rude
~ Take concerns seriously and answer Qs
- Hello there , what seems to be the problem?
- Can I offer some assistance?
~ Aknowledge anger
- I can see that you are upset znd I am sorry that you feel this way, I would be anry too
- Do not accept blame
~ Try to offer practical help
- Offer investigation with receptionist and provide feeback to the patient
- Offer another appointment “ do you have a suitable time we can see you on?”
- What would you like to do , we can work around you
- in order to avoid this from happening again we can incorporate a new system but will need to confirm this with the manager first
~ Make an apology
- Explain how it happens and apologise
- offer amends , is there anything we can do?
~ If formal complaint requested , advise on NHS complaints procedure
- Then if required a local resolution
- if satisfactory then complain closed
- if unsatisfactory then it is referref to the healthcare comission or health service ombdusman
”
~ We have a standard complaint procedure and you do habe the right under the GDC to complain , this will aknowledged within 3 working days , we’ll feedback you by writing
~ Sorry about this again , is the issue resolved now?
~ Thank you for your feedback and complaint as this helps us improve our care”
What is the NHS complaint procedure?
- acknowledge complain and offer practice complaint procedure
- inform dental defence organisation if you require advice
- Acknowledge complain by writing or telephone within 3 days
- Early reolution within 5 days for straighforward cases
- if not resolved , then investigation is to be carried out (20 working days)
- if not resolved then an independent external review ombudsman
You overhear a nurse bad-mouthing a patient to a colleague in a public space in the surgery. They refer to them in a derogatory manner and joke about potentially posting this on social media. The patient and family are easily identifiable from the information discussed. Discuss this issue with your nurse.
~ Introduce yourself
- ask nurse if it is okay to sit down with you and have a minute to talk
- The reason for this discussion is to hear your side of the story about what happened in the reception area
~ Facts
- Ask for her account on the situation
- “ Unfortunately, there were remarks said publicly and a talk about posting on social media, I was wondering if you knew anything about this?”
- Is it okay if i hear a bit more about the conversation?
~ Issues
- Explain that this behaviour causes an issue to the individual
- According to GDC standards , this is considered a breach of confidentiality
- “ I know it may have been misjusged but unfortunately it is not acceptable to say things about pts publicly or to post on social media
- “ As the GDC standards states , it is our oligation to have patient best interest in mind and to protect their information. Speaking in the public can breach confidentiality. for example how would you feel if someone is speaking/posting about your family?”
- “ Also this would make the public lose their confidence with you and in the profession, the practice could be in question and the GDC could be informed of this in the future”
~ Options
- What is the patient best interest?
- There are a few options to make amends :
^ Delete any social media post
^ Apologise to the patient if still available
~ Inform the nurse that this should not happen again
~ Ask/Advise
- Ask if they want to undertake training or education in this matter
- if problem repeats, get advice from someone senior
- Do you have any questions?
~ Document conversation
Statistics (6mins)
Comparison between two mouthwashes
Null hypothesis, 95 confidence , RR of 1.39
~ ARR - absolute risk reduction
- difference of risk between groups
- 0 - value of no difference
~ RR - ratio of risk in each group
- Risk in intervention group/ risk in control group
- 1 - value of no difference
~ NNT (number of patients you would need to treat to prevent one patient from developing the risk)
1/RR
~ 95% CI
- 95 times out of 100 the CI would contain the true population ARD
- The range of values the ARD will take in the population
- Overlaps 0 - insufficient evidence
- Wide confidence interval means small sample size
Give the different types of studies
- RCT - prospective
- Cohort study - prospective
- Case control - retrospectove , pt with diseased matched with non diseased and risk factors observed
- Cross sectional - one single point of time
What are the criteria for a good RCT?
- Blinding
- Randomisation
- Control
- Inclusion and exclusion criteria
What type of study provides the highest level of evidence? and list 4 aspects of this study?
Cochrane reviews which are systematic assessments of all the relevant RCTs
- randomised double blinding
- inclusion and exclusion criteria
- Randomisation
- Conrol groups
Domestic abuse
~ Ask
“ i have noticed some bruises , is everything okay? did somoene hurt you? “
~ Validate
“ you do not deserve to be hurt no matter what happened”
“ It is not your fault”
“ I am concerned about your safety”
~ Document
Be specific and detailed
Use pt own words
Everything the pt mentioned
take photos if possible
~ Refer
There are services that may help in such situations , such as the core Scottish organisation
The Scottish domestic abuse helpline - 0800 027 1234
AVDR
