PMHP Flashcards
Give smoking cessation advice to this patient
- Ask (do you smoke/what do you smoke, how long for, how many a day, people around smoking)
- Advice (risks of smoking to perio and oral cancer, tooth loss)
- Assess motivation (previous attempts)
- Assist (option of referral to services, websites, NRT - increased liklihood of quitting)
- Refer (GP, pharmacy, quit your way. Arrange follow up)
need to be: non judgemental, clear advice, easy to understand, good body language, listening
Complaints Procedure - Pt annoyed they had to wait an hour + receptionist was rude (12 mins)
● Take concerns seriously, answer questions as able:
○ ‘Hello there, what seems to be the problem?’
○ ‘Can i offer some assistance?’
● Acknowledge anger ‘I can see that you’re upset and I am sorry that you feel this way.’
○ This does not accept blame. DO NOT ACCEPT BLAME
● Try to offer practical help:
○ Offer investigation with receptionist and provide feedback to the patient
○ If you can offer another appointment - ‘Do you still have time for us to see you?’
○ ‘What would like to do, we can work around you?’
● Making an apology:
○ Be honest
○ Acknowledge the offence
○ Explain how it happened
○ Express remorse: deep guilt, express it! (I am so sorry!)
○ Ensure amends: ‘Is there anything we can do?’
● If formal complaint requested, advise on NHS complaints procedure
○ Then, if required: a local resolution (payout)
○ If satisfactory: complaint closed
○ If unsatisfactory: healthcare commission or health service ombudsman
● The NHS complaints procedure
1. Acknowledge the complaint and provide the patient with the practice complaint procedure.
2. Inform the dental defence organization if you require advice.
3. Inform the patient of timescales and stages involved.
4. Acknowledge the complaint in writing, by email or by telephone as soon as you receive it – 3 working days maximum but ideally within 24 hours.
5. Early Resolution 5 working days For issues that are straightforward and easily resolved, requiring little or no investigation.
6. Investigation 20 working days For issues that have not been resolved at the early resolution stage or that are complex, serious or ‘high risk’.
7. Independent External Review Ombudsman For issues that have not been resolved
You overhear a nurse bad-mouthing a patient to a colleague in a public place 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 as well. Discuss this issue with your nurse.
● Introduce yourself and ask the nurse if it is ok to sit down with you - ‘Do you have a minute to talk’
● Facts:
○ Facts of the situation, what, when, where, how?
○ Ask the individual for their account of 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?’ - allow the nurse to reply
○ ‘Is it ok if I hear your side of the story?’
● Issues:
○ What is the issue here?
○ Explain the issue to the individual and why it is bad.
○ Quote GDC standards - i.e breach of confidentiality, brings profession into disrepute
○ ‘I know it may have been misjudged. But unfortunately, it is not acceptable to say things publicly about patients or post things on social media.’
○ ‘As the GDC standards state, it is our obligation to have pt best interests and to protect their information. Speaking in the public can breach confidentiality. The patients are recognisable from the posts and this is not protecting them. For example, if it was someone speaking/posting about your family member, how would you feel?’
○ ‘It is also not providing the public with confidence in you, us and the profession as a whole. The practice could be in question and the GDC could be informed of this in the future.’
● Options:
○ If involves patient, what options are there to manage this event (short/medium/long term).
○ What is in the patient’s best interest?
○ ‘There are a few options to rectify this:’
■ ‘If there is a social media post – delete it and any photographs immediately’
■ ‘Apologise to the patient’ if still around…
● If not, the practice can contact patient to ideally attend for a formal apology
● Now:
○ What issues do you need to deal with right now?
○ ‘Inform the nurse that this shouldn’t happen again.’
● Ask/Advise:
○ Ask the individual if they would be willing to undertake training or education on this matter
■ ‘It would be acceptable if we had training on this in the future and have meetings about social media to increase awareness’
■ ‘Would you be willing to have training on this?’
○ If problem repeats:
■ Get advice from someone more senior (defence union, VT trainer) how to manage this.
● Record: document conversation
Complaints – Complaining about colleague and crown that fell off after a week of being placed (6 mins)
● Take concerns seriously, answer questions as able:
○ ‘Hello there, what seems to be the problem?’
○ ‘Can I offer some assistance?’
● Acknowledge anger ‘I can see that you’re upset and I am sorry that you feel this way.’
○ This does not accept blame. DO NOT ACCEPT BLAME
● Try to offer practical help:
○ Offer to take over the treatment over your colleague
○ Offer investigation with colleague and provide feedback to the patient
○ ‘Would you like me to recement the crown?’
○ ‘What would like to do, we can work around you?’
● Making an apology:
○ Be honest
○ Acknowledge the offence
○ Explain how it happened
○ Ensure amends: ‘Is there anything we can do?’
● If formal complaint requested, advise on NHS complaints procedure
○ Then, if required: a local resolution (payout)
○ If satisfactory: complaint closed
○ If unsatisfactory: healthcare commission or health service ombudsman
● The NHS complaints procedure
a. Acknowledge the complaint and provide the patient with the practice complaint procedure.
b. Inform the dental defence organization if you require advice.
c. Inform the patient of timescales and stages involved.
d. Acknowledge the complaint in writing, by email or by telephone as soon as you receive it – 3 working days maximum but ideally within 24 hours.
e. Early Resolution 5 working days For issues that are straightforward and easily resolved, requiring little or no investigation.
f. Investigation 20 working days For issues that have not been resolved at the early resolution stage or that are complex, serious or ‘high risk’.
g. Independent External Review Ombudsman For issues that have not been resolved.
Statistics (6 mins) Gleam MW (new) vs Leading brand mw. Null hypothesis, 95% confidence, Risk Ratio of 1.39
● ARR: the difference in risk between the groups
● RR: the ratio of the risk in each group
● NNT: the number of patients you would need to treat to prevent one patient from developing the risk
● 95% CI: 95 times out of 100 the CI will contain the TRUE value in the entire population
○ Can be determined for both ARR and RR
● Null hypothesis (true or rejected)
○ = The intervention works only as well as the control
● FOR ARR – IF CONFIDENCE INTERVAL RANGE OVERLAPS 0 = NULL HYPOTHESIS
○ i.e. if the risk reduction with intervention was 0 then the intervention is the same as the control
● FOR RR – IF CONFIDENCE INTERVAL RANGE OVERLAPS 1 = NULL HYPOTHESIS
○ i.e. if the ratio with of intervention risk over the control risk was 1 then the intervention and control risk are the same
● YOU CAN ALSO COMMENT ON THE BROADNESS OF THE CI RANGE
○ A narrow range means the study is more representative of the true population results compared to a broad range
● What type of study?
○ Randomised controlled trial: prospective
○ Cohort study: prospective
○ Case-control: retrospective
○ Cross-sectional survey: one single point of time
● Criteria for good randomised controlled trial
○ Blinding, inclusion/exclusion criteria, randomisation, control, all subjects accounted for at the end?
You suspect a patient is suffering domestic abuse. how do you go forward?
● Ask
○ About abuse - in private setting without family members
○ Use non-judgemental language
○ ‘Is everything OK at home?’
○ ‘I’ve noticed you’ve got some bruises on your neck, is everything OK? Has someone hurt you?’
○ ‘I’m worried that you don’t seem your usual self, is everything OK?’
○ ‘Do you feel safe?’
● Validate
○ Provide validating messages that take the blame away from the victim
○ A way of showing your patient that you are concerned about them
○ Removes the blame, shows that you believe them, shows that you are taking this seriously
○ ‘You do not deserve to be hurt or hit no matter what happened’
○ ‘I am concerned about your safety’
○ You should still do this even if your patient denies abuse, it may provide some relief or comfort
○ Helps the victim to start to realise the seriousness of their situation
● Document
○ Be specific and detailed
○ Use the patient’s own words
○ Name, location, witnesses that the patient mentioned
○ Describe injuries in as much detail as possible - Take photographs if able
● Refer
○ To appropriate services
○ Even if they don’t seem keen, still offer as they may go away and think about it
○ Do not attempt to deal with problem yourself - Patient is the one needing to take action, not you
○ The core Scottish organisation is the Scottish Domestic Abuse Helpline – 0800 027 1234
● Communication
○ Introduce self
○ Use the domestic abuse pamphlet
○ Use the ‘secret’ lip balm or pen etc
