quiz 1 Flashcards
autonomy
principle that ensures that patients are afforded the chance to make informed, uncoerced decisions
beneficence
principle that obligates doctors to do everything they can that would benefit or help the patient
non-maleficence
principle of “primum non nocere” (first, do no harm) which obligates doctors to do as little harm as possible
justice
principle of fairness. In health care justice normally refers to distributive justice, which is fairness in distribution of resources
paternalistic model
the guardian
informative model
competent technical expert
interpretive model
counselor or advisor
deliberative model
friend or teacher
patients want their doctor to:
care about them as people, be competent, be effective, be efficient, be an advocate in “the system”
elements of caring
empathy, arrange to meet healthcare needs, respect and non-judgment
elements of effective communication
active and engaged listening-non controlling or interrupting
give info in appropriate doses
choose words carefully and check for meaning
be direct and straightforward but not abrupt
consistent in verbal and nonverbal behaviors
soft but confident tone, slow pace, comfortable appearance
talking constitutes up to ___ of a Dr/Pt interaction but only 7% of the conveyance of humanistic qualities
75%
____ of humanistic quality is conveyed by “tone of voice”
22%
____ is conveyed by visual perception of your body language
55%
what drives empathy
recognition and understanding of another’s viewpoint
examples of bad body language
sighing, crossed arms/legs, head tilt, eye contact, leaning away, tensing of muscles, facial expression, breathing changes, squirming and shifting
examples of good body language
eye contact consistent, forward lean, avoid fidgeting, avoid distracted looks, hands… where are they & what are they doing, facial expressions of concern understanding, nodding of head
LOCQSMATT
location onset chronology quality severity modifying factors associated symptoms treatments (previous) treatment (goals)
three key elements of patient compliance
expectancy that results can be achieved
belief that actions will lead to desire outcome
having attractive or valuable goals
what is the most frequent source of patient dissatisfaction
failure to receive an adequate explanation of the problem
the best ROFs
explain the problem
connect the dots between patients narrative and problems and problems and solutions
empathize with pt & reassure them you have mastery over the situation
eliminate fears, reduce uncertainties, set the stage to achieve goals of care
demonstrate optimism
collaborate with them, codify shared nature of improvement
ROF: step 1
greet the patient
give the problem a name and then explain in lay terms
explain how you got to conclusion using the Hx and exam highlights
Lay terms
explain the cause
ask if there are questions
ROF step 2:
outline goals of care. example of 3 laudable goals:
pain management
return to full function
eliminate the cause of the problems and provide options to prevent it in the future
ask for questions…
ROF step 3:
outline specifics of treatment plan
- treatment modalities you will use
- what each modality will do for the patient
- what it will feel like (will it hurt)
ROF step 4:
explain what you expect in terms of their trajectory of improvement
best guess as to how long it will take to be “done’
enhancing patient compliance with the treatment plan
tie symptoms and limitations to cause of problem
stress patient’s role in recovery
identify barriers to compliance
involve patient in addressing barriers
PARQ
procedures
alternatives
risks
questions
procedure
what you’re going to do and how it will feel ie if it will hurt
alternative
include the “do nothing” option unless it would be patently unsafe
Risks
if it is minor and rare, forget about it
if it is minor and not rare discuss it
if it is major and common- discuss it
if it is major and uncommon or rare- discuss it
if it is major and very rare- depends on what it is
questions
hopefully you’ve been engaging that all along so this is the grand summary “do you have any areas of uncertainty remaining?”
t/f ROF is about explaining what is wrong and how you are going to address it- it is more comprehensive than PARQ
T
t/f PARQ focuses on ensuring a patient understands the treatment options and what can go wrong
T
t/f PARQ can be nested within a ROF- or not
T
t/f PARQ is the minimum requirement before tx
T
t/f PARQ must include opportunity for questions
T
