Patient-Physician Relationship Flashcards Preview

NB 3 Dev & Psych > Patient-Physician Relationship > Flashcards

Flashcards in Patient-Physician Relationship Deck (28)
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1

describe the rights and responsibilities of the physician

  • physician must inform the patient:
    • the nature of the disorder
    • available and recommended treatments
    • probably course if untreated
  • physician must listen to patients' concerns, address them objectively and respect their decisions
  • physicians may refuse to perform an act that conflicts with their moral or ethical principles but must respect the patient's wishes and make appropriate referrals

2

describe the Patients Bill of Rights and the Patient Self-Determination Act

  • Patients Bill of Rights
    • right to receive complete info.
    • right to refuse treatment 
    • right to know about a hospital's financial conflicts of interest
  • Patient Self-Determination Act
    • established that patients must be given written info. about their health care decision making rights and the institutional policy on advance directives

3

what are the 3 main goals of doctor-patient communication?

  1. create a good interpersonal relationship
  2. facilitate exchange of information
  3. include patients in decision making

4

informed patients have a greater sense of control that has been associated with....

  • greater ability to tolerate pain
  • faster recovery from illness
  • enhanced psychological adjustment to illness
  • decreased length of hospital stay

5

what are benefits of good doctor-patient communication?

  • helps regulate patients' emotions
  • facilitates comprehension of medical information
  • allows for better identification of patients' needs, perceptions and expectations
  • patients are more likely to:
    • be satisfied with their care
    • share pertinent info.
    • adhere to the treatment plan
  • patients' agreemenet with the doctor about the nature of the treatment and need for follow-up is strongly associated with their recovery

6

describe methods to improve communication with the patient

  • open/receptive body language
    • sit facing the patient
    • maintain appropriate eye contact
    • pleasant, encouraging tone
  • empathy
    • take time to understand their home life, socioeconomic situation, culture
    • show interest, encouragement, warmth, courteousness and respect

7

tell adults _____ about diagnosis and prognosis

tell adults the complete truth about diagnosis and prognosis

8

9

speak to adult patients directly, not through _____

speak to adult patients directly, not through relatives or staff

10

do not discuss ______ with friends/family without the ______

do not discuss patient care with friends/family without the patients permission

11

do not offer premature reassurance, and do not order a course of action; provide info and let the patient decide

do not offer premature reassurance, and do not order a course of action; provide info and let the patient decide

12

describe barriers to effective communication between physician-patient

  • transferance
    • relationship schemas (beliefs, expectations, perceptions from the past affecting the present)
    • female patient woulnd't disclose all info to male patient in order to look a certain way
  • countertransferance
    • physician's relationship schemas
    • physician's mother dies from cancer, and that makes it hard to give news about cancer to patient

13

describe objectification/dehumanization

  • using the patient as a teaching tool in a teaching hospital in direct view of patient
  • discussing with colleagues in listening range of the patient

14

describe methods to get around sensory impairment and cognitive impairment of the patient

  • sensory impairment
    • be prepared to utilize a sign language interpreter or written materials
  • cognitive impairment
    • provide written instructions for memory impaired patients
    • determine patient competency to understand and comply with treatment recommendations, refer for eval if needed

15

describe patient barriers to treatment adherence

  • fears
    • loss of bodily integrity from medication side effects
    • dependency on others
    • loss of masculinity (playing through an injury)
    • loss of work time, fear of losing their livelihood
  • denial/avoidance
    • refusal to admit being ill or to acknowledge severity
  • regression
    • reverting to immature, attention-seeking behaviors

16

descibe methods to improve treatment adherence

  • medications
    • discussion of patients fears and avoidance strategies
    • higher doses, shorter treatment course
    • assess adherence at every clinical encounter with check-ins between if needed
    • pillbox simulations
  • behavioral interventions
    • enlist caregivers, family members
    • diaries, logs, workbooks

17

describe why some patients like the sick role

  • sick person is exempt from normal social roles
  • not responsible for their condition
  • with physician and social support, the patient must work towards a return to health

18

describe why the sick role is relevant

  • symptoms might not respond to treatment
  • symptoms might extend beyond their normal course
  • "iatrogenic" symptoms

19

describe postcussional syndrome

  • history of head trauma with loss of consciousness preceeding symptoms onset by max of 4 weeks
  • patients hav ea pre-occupation with symptoms and adopt the sick role

20

what are predictors of prolonged recovery in poscussional patients, and what is the single best predictor?

  • predictors
    • initial symptoms of headache and loss of consciousness
    • presenting with >4 symptoms
    • number of prior concussions
    • premorbid neurologic or psychiatric symptoms
    • older age
  • single best predictor = litigation
    • some sort of secondary gain ($$, sick role)

21

describe SPIKES

6-step protocol for conveying bad news to patients

  • Setting up the interview
  • Perception of the patient
  • Invitation
  • Knowledge
  • Emotions/empathy
  • Strategy/summary

22

describe setting up the interview (SPIKES)

  • arrange for privacy
  • involve significant others at the patient's request
  • sit down and maintain eye contact
  • touch the patient's hand or arm (if appropriate)
  • silence your pager and do not answer phone

23

describe perception of the patient (SPIKES)

  • find out what the patient understands about the medical situation 
  • determine if the patient is using denial or wishful thinking
  • determine if the patient has unrealistic expectations about the diagnosis

24

describe invitation (SPIKES)

  • find out how the patient would like to receive the diagnosis and related info
  • find out how much detail the patient wishes to have
  • offer to answer questions in the future
  • offer to talk to a relative or friend

25

describe knowledge (SPIKES)

  • prepare the patient for bad news
  • give the positive news first
  • present bad news clearly and unambiguously
  • give info in small doses and check their understanding
  • use nontechnical words
  • avoid conveying hopelessness

26

describe emotions/empathy (SPIKES)

  • observe the patient's emotions
  • ask the patient about how the news makes them feel
  • connect the emotion with the reason for it
  • be able to sit with their distress and tolerate the discomfort
  • stay near the patient and wait for them to speak
  • ask if anyone should be called

27

describe strategy/summary (SPIKES)

  • ask the patient if they are ready to discuss treatment
  • evaluate the patient's understanding, expectation, and hopes for the future
  • share decision-making responsibility with the patient
  • understand the goals of the patient (i.e. pain control)
  • state immediate plans for care
  • schedule a follow-up visit

28

describe communicating prognosis

  • ask a patient in info about prognosis is desired before providing it
  • balance between realism and compassion
  • give averages and allow for outliers in both directions
    • "the avg person with your illness will live 3-9 months. It could be longer if treatment is successful, but unfortunately, it could be shorter"
    • "let's hope for the best and prepare for the worst"