PPD - Uncertainty In Medical Practice

Question 1

Affective bias

Answer 1

• we tend to prefer to what we hope will happen rather than less appealing alternatives

Question 2

Attribution bias

Answer 2

• patients are prototypes

- gut feeling can be dangerous when emotion is involved

Question 3

Confirmation bias

Answer 3

• selective cognitive cherry picking based on a preconceived idea

Question 4

Momentum bias

Answer 4

• nobody stops to question the diagnosis or clinical situation

Question 5

Commission bias

Answer 5

• tendency to inaction or action

Question 6

Rationalisation

Answer 6

• adopts a distorted or confabulated interpretation of an event
• the interpretation relieves anxiety and confirms a persons self-understanding as a moral individual

Question 7

Euphemistic language

Answer 7

• makes the act seem less harmful

Question 8

Advantageous comparison

Answer 8

• comparing it to something worse
• telling the family will only make them feel worse
• the immoral act trumps the moral act

Question 9

Displacement of responsibility

Answer 9

• somebody else was really to blame

- therefore no need to disclose

Question 10

Diffusion of responsibility

Answer 10

• the responsibility is tranferred to the group

- therefore cant single out who is to blame

Question 11

Attribution of blame

Answer 11

• blaming the vitim of the circumstances for enabling the events to occur
• the patient brought it on themselves

Question 12

Fragmentation

Answer 12

• the individual fragments/splits themselves between the person who made the error and the one who does some good deeds
• divert error to the bad self, but that is not the real person

Question 13

Shared decision making

Answer 13

• both doctor and patient are involved
• information exchange in both directions and by both parties
• mutual deliberation on treatment options
• agreement on treatment
• no a hallmark of good clinical practice, an ethical imperative and a way of enhancing patient engagement and activation
• suggest benefit and increased patient satisfaction if participation preferences are met

Question 14

Clinical skills for shared decision making

Answer 14

• developing a therapeutic relationship with patient
• explain the decision being made
• good communication skills + listening
• askin patient to tell you what they have understood
• support patients and their families to be involved in decision

Question 15

Communicating complex information

Answer 15

• language
• patient understanding
• patient anxiety
• time
• decision aids
• question prompt list
• patient coaching
• consultation audio recording
• option grids
• time to consider decision

Question 16

What does decision support do

Answer 16

• assist consumers to make informed choices about different options in their healthcare
• provides information on options and outcomes
• includes values clarification to weigh up pros and cons
• non-directive

Question 17

Do decision aids work?

Answer 17

• improve knowledge
• lower decisional conflict
• fewer people undecided
• more people accurate risk perception
• less practitioner controlled decision making
• choosing option congruent with values

Question 18

Are question asking interventions effective?

Answer 18

• increased question asking
• increased patient satisfaction
• no increase anxiety
• no increase in consultation length
• enable participants to raise more sensitive issues during consultation

Question 19

Treatment decision questions: ASK

Answer 19

• increased the amount and quality of information given about treatment options and possible outcomes
• improve communication behaviors that encourage patient involvement in decision making
• did not increase consultation time in general practice

Question 20

Summary: Shared decision making

Answer 20

• requires both patient and clinician to consider a healthcare decision together
• is considered best practice and widely endorsed approach to clinical decision making
• is supported on ethical and empirical grounds due to positive effects on decision quality, health outcomes, health service utilization and efficiency of care

Question 21

Communicating uncertainty

Answer 21

• acknowledge uncertainty
• explore prefences and tailor discussion to patient and family in front of you
• consider different ways to explain information so it is understood

Question 22

Decision support tool

Answer 22

• improve the communication of complex information to patients
• increase the quality of patient involvement in care