Risk & Uncertainty Flashcards
What are the aims of a GP consultation?
Gathering information
Providing structure
Building relationship
Explanation and planning
What model do consultations use?
Calgary Cambridge Model
What are the steps of the Calgary Cambridge Model?
1) Initiating the session
2) Gathering information
3) Providing structure
4) Building relationship
5) Explanation and planning
6) Closing the session
What does using a model allow?
Time to gether information with a structure
What is a model consultations can use other than the Calgary Cambridge Model?
Roger Neighbour’s model
What are the steps of Roger Neighbour’s model?
1) Connect with the patient
2) Summarise and verbally check that the reasons for attendance are clear
3) Hand over and bring the consultation to a close
4) Ensure that a safety net exists in that no serious possibility has been missed
5) Deal with housekeeping of recovery and reflection
What does Roger Neighbour’s model start to introduce?
Concept of risk management
What is risk?
Chance of consequences
What does uncertain mean?
Not able to be relied on, not known or definite
What is uncertainty?
State of being not completely confident or sure of something
How does risk within health compare to other areas?
Very high
How do different people perceive risk?
Differently
Risk and uncertainty differs for the same problem depending on the situation, what does this lead to?
Individualising care
What are key points of individualising care?
Different patients have different risks
Dependent on health beliefs, education, social, cultural and economic backgrounds
Risk cannot always be eliminated, but it can be minimalised
What can be said about getting rid of risk?
It cannot always be eliminated, but it can be minimalised
What is risk depending on?
Health beliefs
Educational
Social
Cultural
Economic backgrounds
What do doctors need to be due to working with risk?
Resilient as they may regularly find themselves asking “have I done the right thing”
What does an inability to be resistant lead to?
Burn out
Depression
What positive thing often results due to uncertainty?
Personal growth
When does stress occur?
Imbalance between demands and recources or pressure that exceeds one’s perceived ability to cope
How do doctors deal with stress?
Have coping mechanisms in place like speaking to colleagues
What is a way of minimising risk?
Safety netting
What is safety netting?
Uncertainty should be communicated to the patient
They must know what to look out for and told to seek help if they see this
Maybe arrange a follow up
What are some different categories of sources of guidance to help with risk and uncertainty?
National
Local
Immediate
Colleagues
Peer group
Reflection
What are some national sources of guidance to deal with risk and uncertainty?
National Evidence Based Guidance
SIGN guidance in Scotland
What does SIGN guidance provide?
Peer reviewed guidelines for specific conditions
What are some local sources of guidance to help with risk and uncertainty?
Scottish Referral Guidelines for Suspected Cancer
What should be noted about local sources of guidance for risk and uncertainty compared to national?
They can be different
What is an example of immediate guidance for risk and uncertainty?
Place of work has guidance for life threatening or complex scenarios
Such as emergency management of anaphylaxis
What is immediate guidance for risk and uncertainty helpful for?
Management of acute conditions
What are examples of colleagues for guidance on risk and uncertainty?
Formal such as writing to another doctor for advice about a single patient
Informal discussing problems with a patient with your GP colleagues
What is the aim of reflection?
To improve overtime
How does the Neighbour model of consultation minimises risk due to?
Ensuring both the doctor and patient are agreeing what the issue is today and summarising, where the patient can add or correct information
Safety net, ensure the patient knows what to do if things get worse
Housekeeping, reflects and ensures he did everything correctly
What are some strategies for managing risk and uncertainty?
Develop a good doctor-patient relationship
Consider the use of a checklist for diagnosis
Exclude ‘red flag’ symptoms
Good organisation and note keeping
Forgive yourself and others when managing the unexpected
What is used in primary care since a full systemic enquiry is not possible?
Hypothetico Deductive Reasoning
What is Hypothetic Deductive Reasoning?
Few probable reasons for something, many possible
Know that you might be wrong, without looking at something (objective measure) but this is not always available to you
What is an example of Hypothetico Deductive Process?
1) Maybe 5 diagnostic hypothesis
2) Rare but not immediately concerning diagnosis excluded at this stage
3) Strengthen case for diagnosis through brief history and examination
4) Extend the search thereafter if no diagnosis identified
5) Not about common diagnosis, rather about likely diagnosis
