Communication skills

Question 1

How to counsel

Answer 1

1. Introduction
2. Ask about the patient’s knowledge (why are they here? What has happened so far? What do they know about the conditions/treatment?)
3. Discuss your structure
4. Explain a small chunk, stop and check understanding
5. Pause
6. Explain a small chunk, stop and check understanding
7. Summarise
8. Make a plan
9. Check understanding
10. Offer a leaflet, specialist nurse understanding, follow-up appointment

Question 2

How to explain a disease?

Answer 2

1. Normal anatomy/physiology
2. What the disease is
3. Cause
4. Problems it causes and complications
5. Management

Question 3

How to explain a procedure?

Answer 3

1. Explain what the procedure is
2. Explain the reason for the procedure
3. Explain procedure details (procedure, during, after)
4. Explain risks and benefits

Question 4

How to explain a treatment?

Answer 4

1. Briefly check for any contraindications to the treatment
2. Check condition understanding
3. Explain how the treatment works
4. Explain treatment course and how its taken
5. Explain the side efects

ATHLETICS 
  A - Action
  T - Timelines
  H - How to take
  L - Length
  E - Effects
  T - Tests
  I - Important side effects
  C - Complications
  S - supplementary advice

Question 5

Advise a patient about starting Lithium (ATHLETICS)

Answer 5

Action:
Lithium is a mood stabiliser. The exact mechanism is unknown, but it is thought to enter the cells and interefere with neurotransmitter release and second messenger systems.

Timeline
Taken once or twice daily

How to take:
Tablet, capsule or syrup

Length:
Lifelong usually with regular reviews by psychiatrist

Effects:
1-2 weeks

Tests:

• Before starting, check FBC, U+E, TFT, ECG
• Check lithium level after 5 days, then weekly until stable for 4 weeks, then every 3 months
• Check TFT’s, U+E’s, Ca2+ every 6 months

Important side effects:
GI: abdo pain, nausea, anorexia, diarrhoea, vomiting
Urinary: thirst, polyuria, impaired concentration
Other: metallic taste, fine tremor, weight gain, oedema
Neuromuscular: dysarthria, dizziness, ataxia, muscle twitching, tremor

Complications:
Renal toxicity
Nephrogenic diabetes insipidus
Hypothyroidism

Supplementary advice:
www.biploaruk.org.uk

Question 6

Advise a patient about taking warfarin (ATHLETICS)

Answer 6

Action;
Warfarin thins the blood and does so by blocking vitamin K which is normally used by the body to make proteins that cause the blood to clot.

Timeline:
Once daily (usually in the evening)

How to take:
Tablets:

Length:
DVT = 3 months
PE = 6 months
AF = Lifelong

Effects:
2-3 days

Tests:
Start 5mg for 4 days then test INR on day 5 and 8, adjusting the dose accordingly
start concomitantly with LMWH if immediate effect is required.

Important Side effects:
Bleeding
Diarrhoea
Rash
Hair loss
Nausea

Contraindications:
Pregnancy
Haemorrhagic stroke
Significant bleed
Caution in patient at high fall risk 

Supplementary advice:
Avoid liver, spinach, cranberry juice, alcohol binges
No NSAIDs or aspirin
Given anticoagulant booklet

Question 7

Advise a patient about taking levothyroxine

Answer 7

Action:
Levothyroxine is a synthetic version of the normal hormone produced by the the thyroid gland, call thyroxine. it is given to increase the thyroxine levels back to normal.

Timeline:
Taken once daily before breakfast

How to take:
Tablet

Length:
Lifelong

Effects:
Few weeks

Tests:
Start test dose then review in 2-3 weeks
TSH test every 2-3 months until stable. When stable, check annually.

Important side effects:
Hyperthyroid symptoms if Thyroxine raises too high

Complications/ contraindications

Supplementary advice:
Free prescriptions

Question 8

Advise a patient about taking statins. (ATHLETICS)

Answer 8

Action;
Statins stop the liver making cholesterol. Cholesterol is one of the things which predisposes to artery problems causing heart disease, stroke and kidney disease.

Timeline:
Once daily = evening

How to take:
Tablet

Length:
Lifelong

Effects:
Decreases risk over many years

Tests:
Review in 4 weeks, then every 6 months.
LFT’s before starting, at 3 months and at 12 months

Side effects:
Muscle pains
Hair loss
Itching
Nausea, sickness, diarrhoea, abdominal pain

Contraindications:
Pregnancy

Supplementary advice:
Avoid grapefruit

Question 9

Advise a patient about taking metformin (ATHLETICS)

Answer 9

Action:
Metformin increase the sensitivity of cells to insulin, thereby allowing the body to make better use of the lower insulin levles

Timelines:
once daily with breakfast

How to take:
Take tablet with or immediately after a meal at the same time each day

Length:
Lifelong (if it works)

Effects:

Tests:
U&E before starting, then annually

Important side effects:
Nausea
Diarrhoea
Abdo pain
Weight loss
Lactic acidosis (complication)

Contraindications:
Renal impairment
Ketoacidosis
Low BMI
Metformin must not be taken on the day of, and for 2 days after having general anaesthetic or X-ray contrast media

Supplementary advice:
If you miss a dose, take it as soon as remembered unless its close to next dose time

Question 10

Advise a patient about taking iron tablets. (ATHLETICS)

Answer 10

Action:
Iron tablets replace your body’s store of iron, a mineral required to make RBC’s, which is deficient

Timeline
1-3 times daily

How to take:
Works best if taken on an empty stomach but most take with food because iron can irritate the stomach

Length:
Usually 4 months (3-4 weeks for Hb to normalise, then takes 3 months after that to replenish stores)

Effects:
3-4 weeks

Tests:
Hb in 3-4 weeks

Important side effects
GI irritations (N, V + D)
Coloured stools
Tastes bad

Contraindications:

Supplementary advice: