The Consultation & Beyond Flashcards
What are the 3 goals of a medical consultation?
- Develop a good relationship between healthcare provider and patient
- Exchange relevant information
- Make relevant decisions
What are the 5 main phases of a typical medical consulation?
- HCP establishes relationship with patient
- HCP finds out reason for patient’s attendance
- HCP conducts verbal/physical examination
- HCP and/or patient considers the condition
- HCP considers further treatment/investigation
What are the 6 key dimensions important to a good medical consultation?
- Having good knowledge of research/medical info & being able to communicate it to the patient
- Achieving a good relationship with the patient
- Establishing the nature of the problem
- Understanding the patient’s understanding of their problem/consequences
- Engaging the patient in the decision-making process
- Managing time/not rushing
What are the characteristics of the professional-centred approach?
- HCP has control over the interview
- HCP asks questions to gain info
- HCP makes the decision
- Patient passively accepts the decision
What are the characteristics of the patient-centred approach?
- HCP identifies & works with the patient’s agenda
- HCP listens to the patient & responds appropriately
- HCP encourages engagement, seeks patients ideas of what is wrong/how it may be treated
- Patient is an active participant in the process
What are the key features of shared decision-making?
- Involves at least 2 people (HCP & patient)
- Both parties participate in the decision making
- Information sharing
- Both parties agree with the decision
What are some of the reasons why shared decision making might not be easy for the patient?
- Lacks a framework of medical decision making
- Lack of medical vocabulary
- Emotionally vulnerable
- New environment
- Feeling powerless
What are the 6 steps of the patient-centred approach for shared decision making?
- Expore the patient’s ideas about their problem/treatments
- Identify how much info the patient would prefer
- Check the patient’s understanding of ideas/fears/expectations of treatments
- Assess patient’s decision making preference
- Make, discuss or defer decisions
- Arrange follow-up
What are some of the positive outcomes from shared decision making?
Satisfaction
Adherence
Psychological adjustment
Symptom resolution
When did Zachariae (2003) find patients were more satisfied and confident?
- When the doctor attempted gain an understanding of their viewpoint
- When the physician understood their feelings
- When they felt the doctor could handle the medical aspects of their care
- When the quality of their personal contact with the doctor was high
What are some of the factors that influence the process/style of the consultation?
- Type of HCP
- Gender of HCP
- Way the info is given
- Patient’s contribution
- Ethnicity
What is the 6 step protocol for breaking bad news?
- Give the news in person, in private, with enough time & without interruption
- Find out what the patient knows about their diagnosis
- Find out what the patient wants to know
- Share the information gradually (start with a warning shot, then small amounts of simple info)
- Respond to the patient’s feelings/emotional reaction
- Plan/follow through
What are 3 ways doctors arrive at a diagnosis?
- Hypothesis testing
- Pattern recognition
- Opinion revision or ‘heuristics and biases’
What are diagnostic heuristics?
Diagnostic short cuts which help doctors make quick decisions when there is minimal information
What are some of the factors that may bias diagnostic heuristics?
- Availability: Assuming high probability of a condition because it receives more media attention
- Representativeness: Not taking into account the likelihood of 2 conditions being present
- Potential pay-off of differing diagnoses: Diagnosis assigned may carry the least cost/be the most beneficial
