The Consultation & Beyond Flashcards

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1
Q

What are the 3 goals of a medical consultation?

A
  • Develop a good relationship between healthcare provider and patient
  • Exchange relevant information
  • Make relevant decisions
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2
Q

What are the 5 main phases of a typical medical consulation?

A
  • 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
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3
Q

What are the 6 key dimensions important to a good medical consultation?

A
  • 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
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4
Q

What are the characteristics of the professional-centred approach?

A
  • HCP has control over the interview
  • HCP asks questions to gain info
  • HCP makes the decision
  • Patient passively accepts the decision
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5
Q

What are the characteristics of the patient-centred approach?

A
  • 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
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6
Q

What are the key features of shared decision-making?

A
  • Involves at least 2 people (HCP & patient)
  • Both parties participate in the decision making
  • Information sharing
  • Both parties agree with the decision
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7
Q

What are some of the reasons why shared decision making might not be easy for the patient?

A
  • Lacks a framework of medical decision making
  • Lack of medical vocabulary
  • Emotionally vulnerable
  • New environment
  • Feeling powerless
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8
Q

What are the 6 steps of the patient-centred approach for shared decision making?

A
  • 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
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9
Q

What are some of the positive outcomes from shared decision making?

A

Satisfaction
Adherence
Psychological adjustment
Symptom resolution

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10
Q

When did Zachariae (2003) find patients were more satisfied and confident?

A
  • 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
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11
Q

What are some of the factors that influence the process/style of the consultation?

A
  • Type of HCP
  • Gender of HCP
  • Way the info is given
  • Patient’s contribution
  • Ethnicity
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12
Q

What is the 6 step protocol for breaking bad news?

A
  • 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
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13
Q

What are 3 ways doctors arrive at a diagnosis?

A
  • Hypothesis testing
  • Pattern recognition
  • Opinion revision or ‘heuristics and biases’
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14
Q

What are diagnostic heuristics?

A

Diagnostic short cuts which help doctors make quick decisions when there is minimal information

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15
Q

What are some of the factors that may bias diagnostic heuristics?

A
  • 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
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16
Q

What are some of the factors that predict poor adherence to medication?

A
  • Social: Low education, unemployment, low social support, drug use
  • Psychological: High anxiety/depression, denial, uninformed/inaccurate beliefs about taking medications for a long time
  • Treatment: Misunderstandings, complexity of regime, side effects, little obvious benefit, poor relationship with HCP
17
Q

What are 3 strategies within the consultation that can increase knowledge about a condition & adherence to treatment?

A
  • Maximise satisfaction with process of treatment
  • Maximise understanding of the condition & its treatment
  • Maximise memory for information given
18
Q

What are the most effective interventions to maximise adherence to chronic disease treatments?

A
  • Convenient time
  • Relevant information
  • Reminders to take meds
  • Self-monitoring
  • Reinforcement of appropriate use
  • Family therapy