Risk & Uncertainty

Question 1

What are the aims of a GP consultation?

Answer 1

Gathering information

Providing structure

Building relationship

Explanation and planning

Question 2

What model do consultations use?

Answer 2

Calgary Cambridge Model

Question 3

What are the steps of the Calgary Cambridge Model?

Answer 3

1) Initiating the session
2) Gathering information
3) Providing structure
4) Building relationship
5) Explanation and planning
6) Closing the session

Question 4

What does using a model allow?

Answer 4

Time to gether information with a structure

Question 5

What is a model consultations can use other than the Calgary Cambridge Model?

Answer 5

Roger Neighbour’s model

Question 6

What are the steps of Roger Neighbour’s model?

Answer 6

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

Question 7

What does Roger Neighbour’s model start to introduce?

Answer 7

Concept of risk management

Question 8

What is risk?

Answer 8

Chance of consequences

Question 9

What does uncertain mean?

Answer 9

Not able to be relied on, not known or definite

Question 10

What is uncertainty?

Answer 10

State of being not completely confident or sure of something

Question 11

How does risk within health compare to other areas?

Answer 11

Very high

Question 12

How do different people perceive risk?

Answer 12

Differently

Question 13

Risk and uncertainty differs for the same problem depending on the situation, what does this lead to?

Answer 13

Individualising care

Question 14

What are key points of individualising care?

Answer 14

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

Question 15

What can be said about getting rid of risk?

Answer 15

It cannot always be eliminated, but it can be minimalised

Question 16

What is risk depending on?

Answer 16

Health beliefs

Educational

Social

Cultural

Economic backgrounds

Question 17

What do doctors need to be due to working with risk?

Answer 17

Resilient as they may regularly find themselves asking “have I done the right thing”

Question 18

What does an inability to be resistant lead to?

Answer 18

Burn out

Depression

Question 19

What positive thing often results due to uncertainty?

Answer 19

Personal growth

Question 20

When does stress occur?

Answer 20

Imbalance between demands and recources or pressure that exceeds one’s perceived ability to cope

Question 21

How do doctors deal with stress?

Answer 21

Have coping mechanisms in place like speaking to colleagues

Question 22

What is a way of minimising risk?

Answer 22

Safety netting

Question 23

What is safety netting?

Answer 23

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

Question 24

What are some different categories of sources of guidance to help with risk and uncertainty?

Answer 24

National

Local

Immediate

Colleagues

Peer group

Reflection

Question 25

What are some national sources of guidance to deal with risk and uncertainty?

Answer 25

National Evidence Based Guidance

SIGN guidance in Scotland

Question 26

What does SIGN guidance provide?

Answer 26

Peer reviewed guidelines for specific conditions

Question 27

What are some local sources of guidance to help with risk and uncertainty?

Answer 27

Scottish Referral Guidelines for Suspected Cancer

Question 28

What should be noted about local sources of guidance for risk and uncertainty compared to national?

Answer 28

They can be different

Question 29

What is an example of immediate guidance for risk and uncertainty?

Answer 29

Place of work has guidance for life threatening or complex scenarios

Such as emergency management of anaphylaxis

Question 30

What is immediate guidance for risk and uncertainty helpful for?

Answer 30

Management of acute conditions

Question 31

What are examples of colleagues for guidance on risk and uncertainty?

Answer 31

Formal such as writing to another doctor for advice about a single patient

Informal discussing problems with a patient with your GP colleagues

Question 32

What is the aim of reflection?

Answer 32

To improve overtime

Question 33

How does the Neighbour model of consultation minimises risk due to?

Answer 33

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

Question 34

What are some strategies for managing risk and uncertainty?

Answer 34

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

Question 35

What is used in primary care since a full systemic enquiry is not possible?

Answer 35

Hypothetico Deductive Reasoning

Question 36

What is Hypothetic Deductive Reasoning?

Answer 36

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

Question 37

What is an example of Hypothetico Deductive Process?

Answer 37

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