Risk and Uncertainty

Question 1

Aims of a consultation:

Answer 1

• Initiating the session
• Gathering information
• Providing structure
• Building relationship
• Closing the session
• ‘Calgary-Cambridge model’

Question 2

Neighbour’s approach to a consultation:

Answer 2

• To connect with the patient
• To summarise and verbally check that the reasons for attendance are clear
• To hand over and bring the consultation to a close
• To ensure that a safety net exists in that no serious possibilities have been missed
• To deal with the housekeeping of recovery and reflection

Question 3

Concept of safety netting:

Answer 3

• Have we understood and checked the real reason the patient was there?
• Have we missed anything? How do we minimise the chance of future problems?
• Am I ready for the next consultation?

Question 4

Risk:

Answer 4

likelihood of consequences, loss etc

Question 5

Uncertain:

Answer 5

not to be relied on; not known or definite

Question 6

Uncertainty (personal):

Answer 6

state of not being completely confident or sure of something

Question 7

Strategies for managing uncertainty:

Answer 7

• Developing a good doctor-patient relationship is vital
• Consider each patient as an individual and take their background into consideration - support, social network, education
• Use external evidence (evidence-based medicine) and respect the internal evidence (patient’s and doctor’s)
• Use of a checklist for diagnosis - mental/documented checklists e.g. excluding ‘red flag’ symptoms
• Good organisation and note keeping (includes documentation of safety netting)
• Be aware of your feelings and acknowledge them - be able to forgive yourself and others when managing the unexpected
• Apply reflective practice
• Peer group discussions with senior/specialist colleagues on problematic cases

Question 8

In primary care, a full systematic enquiry is not possible, so we use ‘Hypothetico-deductive Reasoning’:

Answer 8

• Maybe 4/5 diagnostic hypotheses
• Rare but not immediately concerning diagnoses excluded at this stage
• Strengthen case for diagnoses through brief history and examination
• Extend the search thereafter if no diagnosis is identified
• Not about common diagnoses, rather about likely diagnoses

Question 9

Safety netting advice:

Answer 9

• Advise expected course of illness/recovery
• Advise of symptoms indicating deterioration
• Advise who to contact if patient deteriorates