Risk, Uncertainty and Problem Solving Flashcards Preview

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Flashcards in Risk, Uncertainty and Problem Solving Deck (24):

What are the 6 aims of a consultation?

Initiating the session
Gathering information
Providing structure
Building relationship
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


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?

Peer groups


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