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Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
Management & Medicolegal Issues
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Management & Medicolegal Issues

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  • 1. DR/KHALID AL-HARBY<br />MANAGEMENT & MEDICOLEGAL ISSUES<br />DR/ KHALID DHAIFULLAH AL-HARBY<br />MBBS,ABFM,SBFM<br />
  • 2. DR/KHALID AL-HARBY<br />Patient management(CRAPRIOP)<br />C: Clarification<br />R: Reassurance (should be appropriate)<br />A: Advice, counseling ( must be realistic , individualized)<br />P: Prescription<br />R: Referral (or consultation)<br />I: Investigation<br />O: Observation<br />P: Prevention<br />
  • 3. DR/KHALID AL-HARBY<br />Prescribing Qs to be asked<br />What are the clinical aims of prescribing for this particular patient?<br />therapeutic:<br /><ul><li>prevention (e.g. antibiotics prior to dental procedure)
  • 4. Curative (e.g gamma benzene hexachloride lotion for scabies)
  • 5. Symptomatic (e.g. NSAIDs for osteoarthritis)</li></li></ul><li>DR/KHALID AL-HARBY<br />b) Tactile:<br /><ul><li>to gain time when collecting more information (e.g antacid for patient with dyspepsia who is waiting for endoscopy
  • 6. As a trial of treatment (e.g a course of Na cromoglycate if ? Exercise-induced asthma
  • 7. To relieve doctor’s anxiety when uncertain of diagnosis </li></ul>c) both<br />
  • 8. DR/KHALID AL-HARBY<br />What evidence is there that the natural history of this problem will be helped by any medication? e.g. antibiotics for URTIs<br />What evidence is available regarding: comparative effectiveness (24 different NSAIDs in BNF), hazards, costs?<br />CI, interactions, optimal dosage and duration?<br />What are the factors that affects patient’s compliance?<br />Is there a need for supervision?<br />
  • 9. DR/KHALID AL-HARBY<br />The doctor-patient relationship<br />Has 3 elements:<br /> therapeutic alliance<br /> transference<br />counter transference<br />Causes of wrong relationships:<br />Assumptions<br />Detachment<br />Anxiety<br />4) Difficult patient<br />5) Frequent attendance<br />6) Dependence<br />
  • 10. DR/KHALID AL-HARBY<br />The doctor-patient relationship<br />Seating strategies: co-operation, confrontation, conversation<br />
  • 11. DR/KHALID AL-HARBY<br />Types of questions:<br />Open (tell me how it affects you?)<br />Probing ( what aggravates the pain?)<br />Prompts ( you say the pain comes on when you move. Can you describe more precisely what movements brings it on?)<br />Closed (have you lost weight?)<br />Leading (would you agree that this pain could be due to anxiety?)<br />Double-barrelled ( have you tried taking paracetamol…or an antacid for your pain?)<br />
  • 12. DR/KHALID AL-HARBY<br />Anticipatory care<br />Prevention + Health promotion (encourages people to achieve the best possible level)<br />Preliminary prevention<br />Primary prevention (H.E., prophylaxis)<br />Secondary prevention (screening, case finding)<br />Tertiary prevention<br />Opportunistic health promotion<br />
  • 13. DR/KHALID AL-HARBY<br />Ethics in practice<br />Fundamental ethical principles in health care:<br />Justice ( or equity)<br />Beneficence ( and non-maleficence)<br />Respect for persons<br />
  • 14. DR/KHALID AL-HARBY<br />Respect for persons<br />Respect for patient autonomy (can be reduced but never absence; people must be allowed to control their health)<br />Informed consent<br />Truth-telling<br />Respect for confidentiality<br />
  • 15. DR/KHALID AL-HARBY<br />Ethics v.s Medico legality<br />A gift given to you by a rich man or drug representative!!! How to deal with it?<br />Young man with STD (not to tell the wife!!)<br />Colleague&apos;s mistake written in the file!<br />Giving diagnosis for a relative on the telephone!<br />Annual appraisal of colleagues (implications on all) <br />How is your supervisor?<br />

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