Risk, Uncertainty and Problem Solving Flashcards
What are the 6 aims of a consultation?
Initiating the session Gathering information Providing structure Building relationship Explanation Closing the session
What are the 5 steps in the approach to a consultation set out by Roger Neighbour?
Connect with patient
Summarise and verbally check the reasons for attendance is clear
Hand over and bring consultation to a close
Safety netting
Deal with Housekeeping of recovery and reflection
What is the benefit of using Neighbour’s model?
Involves risk management: Understood real reason for patient attendance Incase missed anything Minimise chance of future problems Prepared for next consultation
Is risk perceived by different people or the same?
All different (i.e. patients, doctors, government)
What is safety netting?
Technique to ensure that doctor has understaff and checked the real reason the patient is there and to ensure they haven’t missed anything important
Define risk
Chance of consequences occurring
Define uncertain
Not able to be relied on
Define uncertainty
State of being not completely confident or unsure of something
What does the level of risk and uncertainty depend on?
On the situation
I.e. experienced mum with medical background presents with severed child, but comfortable with more conservative path
What must be taken into the account to individualise care?
Patients background: Health beliefs Education Social Cultural Economic
Give example of individualising care
Elderly female patient develops pneumonia and requires antibiotics:
One might live in isolation and mild memory loss
Patient of same age and problem may be living in retirement complex with warden to hardened
Different social setting might mean difference between needing admission vs being able to cope and recover at home
What is resilience?
Skill required for doctors to allow them to deal with uncertainty from medical issues and interpersonal aspects and interactions
What is stress the result of?
Imbalance between demands and resources or occurring when pressure exceeds one’s ability to cope
What is career resilience?
Ability to adapt to changing circumstances, even when they’re discouraging or disruptive
How do you safety net in a consultation?
If there is uncertainty, then tell patient
They need to know what to look out for and how to seek for help
Could arrange follow up or by phone
Need to know what to expect over time course where they can find further information
However, need to be clear that if patient has concerns, they should not delay in seeking further medical advice
What are 6 different guidelines to help deal with risk and uncertainty?
National Local Immediate Colleagues Peer groups Reflection
Give example of national guidelines for dealing with risk and uncertainty
Scotland: SIGN
UK: NICE guideline
Peer reviewed guidelines for specific conditions
What are the use local guidelines for dealing with risk and uncertainty and give example
Local guidelines useful for clinical uncertainty about what step to take next, or who to refer to
I.e. Scottish referral guidelines for suspected cancer
What is the use of immediate guidance or protocol when dealing with risk and uncertainty?
Management of acute condition, which you might not have managed for some time i.e. anaphylaxis
How can discussion with colleagues and reflection be useful when dealing with risk and uncertainty?
Could be formal: writing to specific specialty to ask advice about patient
Informal: discussing problems with a patient to your GP colleagues, or interpreting data
All GPs reflect on their one decisions and performance
What are strategies that can help with managing risk of uncertainty?
Good doctor-patient relationship
Consider each patient as an individual and take their background into consideration (support, social network, education)
Use external based evidence
Use mental (or documented ) checklists to red flag signs
Good communication and note keeping, and ensuring patients fully understand and are happy with explanation of management plan
Be aware of your feelings and acknowledge them
Reflective practice
Peer group discussion
What is Hypothetico-Deductive Reasoning?
When patient history leads to making several diagnostic hypotheses
-Rare hypotheses excluded at this stage
How do you determine likely diagnoses through hypothetical deductive reasoning?
More detailed history and exam - may provide evidence for initial hypotheses, but if not:
Extend search
It’s about LIKELY diagnosis, not common
If patient does not follow expected pattern of illness/recovery from postulated diagnosis, revision of the diagnosis required
What is important to note about Hypothetical -Deductive reasoning?
Some causes more probable than others
But also have to keep important, although rare, possibilities in mind
