Risk, Uncertainty and Problem Solving

Question 1

What are the 6 aims of a consultation?

Answer 1

Initiating the session 
Gathering information 
Providing structure 
Building relationship 
Explanation 
Closing the session

Question 2

What are the 5 steps in the approach to a consultation set out by Roger Neighbour?

Answer 2

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

Question 3

What is the benefit of using Neighbour’s model?

Answer 3

Involves risk management:
Understood real reason for patient attendance 
Incase missed anything 
Minimise chance of future problems 
Prepared for next consultation

Question 4

Is risk perceived by different people or the same?

Answer 4

All different (i.e. patients, doctors, government)

Question 5

What is safety netting?

Answer 5

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

Question 6

Define risk

Answer 6

Chance of consequences occurring

Question 7

Define uncertain

Answer 7

Not able to be relied on

Question 8

Define uncertainty

Answer 8

State of being not completely confident or unsure of something

Question 9

What does the level of risk and uncertainty depend on?

Answer 9

On the situation

I.e. experienced mum with medical background presents with severed child, but comfortable with more conservative path

Question 10

What must be taken into the account to individualise care?

Answer 10

Patients background:
Health beliefs
Education 
Social 
Cultural 
Economic

Question 11

Give example of individualising care

Answer 11

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

Question 12

What is resilience?

Answer 12

Skill required for doctors to allow them to deal with uncertainty from medical issues and interpersonal aspects and interactions

Question 13

What is stress the result of?

Answer 13

Imbalance between demands and resources or occurring when pressure exceeds one’s ability to cope

Question 14

What is career resilience?

Answer 14

Ability to adapt to changing circumstances, even when they’re discouraging or disruptive

Question 15

How do you safety net in a consultation?

Answer 15

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

Question 16

What are 6 different guidelines to help deal with risk and uncertainty?

Answer 16

National 
Local 
Immediate 
Colleagues
Peer groups 
Reflection

Question 17

Give example of national guidelines for dealing with risk and uncertainty

Answer 17

Scotland: SIGN
UK: NICE guideline

Peer reviewed guidelines for specific conditions

Question 18

What are the use local guidelines for dealing with risk and uncertainty and give example

Answer 18

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

Question 19

What is the use of immediate guidance or protocol when dealing with risk and uncertainty?

Answer 19

Management of acute condition, which you might not have managed for some time i.e. anaphylaxis

Question 20

How can discussion with colleagues and reflection be useful when dealing with risk and uncertainty?

Answer 20

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

Question 21

What are strategies that can help with managing risk of uncertainty?

Answer 21

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

Question 22

What is Hypothetico-Deductive Reasoning?

Answer 22

When patient history leads to making several diagnostic hypotheses
-Rare hypotheses excluded at this stage

Question 23

How do you determine likely diagnoses through hypothetical deductive reasoning?

Answer 23

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

Question 24

What is important to note about Hypothetical -Deductive reasoning?

Answer 24

Some causes more probable than others

But also have to keep important, although rare, possibilities in mind