Zackary Berger gave a seminar on encouraging patient autonomy in theory and practice. He discussed how patient autonomy is viewed in theory as patients making their own medical decisions after considering treatment options and risks/benefits. However, in practice generic opening questions from doctors do not effectively elicit patients' concerns and agendas are rarely jointly discussed. Berger presented research finding most visits started with a general question from the doctor without further probing of patient concerns. The research also found agendas were usually physician-directed rather than negotiated. Berger recommended interventions to improve discussing concerns and jointly setting visit agendas to better encourage patient autonomy in clinical practice.
Calgary Cambridge Guide to the Medical Interviewmeducationdotnet
The document outlines the communication process for conducting a medical interview, including establishing rapport, gathering information, providing structure, building relationships, explanation and planning, and closing the session. It discusses important skills at each stage, such as actively listening to the patient, summarizing to check understanding, explaining diagnoses and treatment plans, and making a mutually agreed upon plan. The overall goal is for the physician to understand the patient's perspective and concerns and work together on a plan of care.
Calgary Cambridge model of consultationWafa sheikh
This document provides an overview of the Calgary Cambridge consultation model. It discusses the importance of consultation models for improving patient care. The Calgary Cambridge model outlines 5 stages of a consultation: initiating the session, gathering information, explanation and planning, closing the session, and optional explanation and planning. Each stage contains specific communication skills and goals to help structure a thorough and patient-centered consultation.
This document discusses several models of the patient-doctor consultation process:
1. Berne's Transactional Model views human psychology as consisting of three ego states - parent, adult, and child - that influence how individuals think, feel and behave.
2. Rosenstock's Health Belief Model looks at how patients' beliefs about their vulnerability to illness and the seriousness of a condition affect their acceptance of a doctor's advice.
3. Heron's Sex-Category Intervention Analysis categorizes doctors' interventions as informative, prescriptive, confronting, cathartic, catalytic or supportive.
4. Neighbour's Inner Consultation Model outlines five tasks: connecting, summarizing, handing over,
The document discusses various models and frameworks for conducting medical consultations. It describes Pendleton's model which outlines six key tasks for a consultation including defining the patient's reasons for attending, understanding their ideas and expectations, examining any medical issues, and developing a treatment plan. The document also discusses Neighbour's three phase model of connecting with the patient, summarizing the clinical issues, and ensuring the patient accepts the treatment approach. Effective communication is identified as important for quality patient care.
Communication skills in clinical practice for undergraduatessyahnaz74
The document provides information on effective communication skills for clinical practice. It discusses:
1) The importance of communication and key principles like establishing rapport, allowing time, sending clear messages, and having positive attitudes.
2) The need for communication skills during medical consultations to obtain complete diagnoses by understanding patients' physical, emotional and social concerns.
3) Recommendations for positive behaviors like addressing patients respectfully, making them comfortable, focusing on them, and using open-ended questions.
This document discusses the importance of communication skills for physicians. It notes that communication impacts diagnosis, adherence, patient and physician satisfaction, and malpractice litigation. Poor communication is cited as the most common factor in patients deciding to sue. The document advocates that communication is a medical procedure and skills can be learned. It outlines four essential communication tasks for physicians: engage the patient, empathize with them, educate them, and enlist them in their own care. Specific techniques are provided for each task to improve outcomes like adherence, patient empowerment, and satisfaction.
This document discusses the difficulties in measuring and defining grief as well as opportunities for future grief research. It notes that while grief research can benefit participants, it also raises ethical concerns. It also summarizes debates around defining grief, differentiating between normal and pathological grief, and tools that have been used to measure grief. The document advocates for more research on non-pathological grief, tools to measure growth after bereavement, and interventions that can promote progress in grief.
This document outlines Marc Imhotep Cray's presentation on communication skills in clinical medicine. It discusses how communication impacts diagnosis, adherence, patient satisfaction, physician satisfaction, and malpractice litigation. It presents techniques for engaging patients, demonstrating empathy, educating patients, and enlisting patients in their own healthcare. These include asking open-ended questions, acknowledging emotions, explaining diagnoses and treatments clearly, and discovering patients' perspectives. The goal is to improve outcomes through effective physician-patient relationships and partnerships.
Calgary Cambridge Guide to the Medical Interviewmeducationdotnet
The document outlines the communication process for conducting a medical interview, including establishing rapport, gathering information, providing structure, building relationships, explanation and planning, and closing the session. It discusses important skills at each stage, such as actively listening to the patient, summarizing to check understanding, explaining diagnoses and treatment plans, and making a mutually agreed upon plan. The overall goal is for the physician to understand the patient's perspective and concerns and work together on a plan of care.
Calgary Cambridge model of consultationWafa sheikh
This document provides an overview of the Calgary Cambridge consultation model. It discusses the importance of consultation models for improving patient care. The Calgary Cambridge model outlines 5 stages of a consultation: initiating the session, gathering information, explanation and planning, closing the session, and optional explanation and planning. Each stage contains specific communication skills and goals to help structure a thorough and patient-centered consultation.
This document discusses several models of the patient-doctor consultation process:
1. Berne's Transactional Model views human psychology as consisting of three ego states - parent, adult, and child - that influence how individuals think, feel and behave.
2. Rosenstock's Health Belief Model looks at how patients' beliefs about their vulnerability to illness and the seriousness of a condition affect their acceptance of a doctor's advice.
3. Heron's Sex-Category Intervention Analysis categorizes doctors' interventions as informative, prescriptive, confronting, cathartic, catalytic or supportive.
4. Neighbour's Inner Consultation Model outlines five tasks: connecting, summarizing, handing over,
The document discusses various models and frameworks for conducting medical consultations. It describes Pendleton's model which outlines six key tasks for a consultation including defining the patient's reasons for attending, understanding their ideas and expectations, examining any medical issues, and developing a treatment plan. The document also discusses Neighbour's three phase model of connecting with the patient, summarizing the clinical issues, and ensuring the patient accepts the treatment approach. Effective communication is identified as important for quality patient care.
Communication skills in clinical practice for undergraduatessyahnaz74
The document provides information on effective communication skills for clinical practice. It discusses:
1) The importance of communication and key principles like establishing rapport, allowing time, sending clear messages, and having positive attitudes.
2) The need for communication skills during medical consultations to obtain complete diagnoses by understanding patients' physical, emotional and social concerns.
3) Recommendations for positive behaviors like addressing patients respectfully, making them comfortable, focusing on them, and using open-ended questions.
This document discusses the importance of communication skills for physicians. It notes that communication impacts diagnosis, adherence, patient and physician satisfaction, and malpractice litigation. Poor communication is cited as the most common factor in patients deciding to sue. The document advocates that communication is a medical procedure and skills can be learned. It outlines four essential communication tasks for physicians: engage the patient, empathize with them, educate them, and enlist them in their own care. Specific techniques are provided for each task to improve outcomes like adherence, patient empowerment, and satisfaction.
This document discusses the difficulties in measuring and defining grief as well as opportunities for future grief research. It notes that while grief research can benefit participants, it also raises ethical concerns. It also summarizes debates around defining grief, differentiating between normal and pathological grief, and tools that have been used to measure grief. The document advocates for more research on non-pathological grief, tools to measure growth after bereavement, and interventions that can promote progress in grief.
This document outlines Marc Imhotep Cray's presentation on communication skills in clinical medicine. It discusses how communication impacts diagnosis, adherence, patient satisfaction, physician satisfaction, and malpractice litigation. It presents techniques for engaging patients, demonstrating empathy, educating patients, and enlisting patients in their own healthcare. These include asking open-ended questions, acknowledging emotions, explaining diagnoses and treatments clearly, and discovering patients' perspectives. The goal is to improve outcomes through effective physician-patient relationships and partnerships.
This document discusses values-based practice (VBP) in clinical decision making. It provides the story of the author's 94-year old aunt who was hospitalized for pneumonia and the challenges in determining her care plan. The document then outlines the key principles of VBP, which includes incorporating both scientific evidence and patient/family values and preferences. It emphasizes using communication strategies like shared decision making to develop optimal care plans that account for both medical and personal perspectives.
A short sharing on doctor-patient communication to First year medical students in Universiti Malaysia Sarawak, to be supplemented with anecdotal accounts.
This document discusses effective doctor-patient communication. It emphasizes the importance of listening to patients, understanding their perspectives, and engaging them as partners in their care. Specific communication skills are outlined, including making eye contact, focusing attention, interpreting patients' messages, gathering information respectfully, and explaining diagnoses and treatment plans. The document also provides guidance on breaking bad news sensitively, showing empathy, and addressing cultural and language barriers to ensure patients feel heard, informed, and empowered. The overarching goal of these techniques is to establish trust and improve health outcomes through comprehensive, patient-centered care.
Zackary Berger gave a seminar on encouraging patient autonomy in practice. He discussed how patient autonomy is viewed in theory as patients evaluating treatment options based on their own values, but in reality patients often do not feel able to make autonomous decisions. The study examined how physicians elicit patient concerns in HIV clinic visits. It found that generic opening questions did not effectively elicit concerns, and physicians did not typically probe further after patients responded that they were "fine". When setting visit agendas, physicians often directed the agenda rather than exploring patient priorities.
Essay plan for "To what extent can diagnosis be reliable and valid?"LauraSw
Yes, the title "To what extent can diagnosis be reliable and valid?" was referred to throughout the plan by discussing how diagnosis can only be reliable and valid to a limited extent.
The critical thinking was well integrated by discussing limitations and issues around reliability and validity of diagnosis and supporting the arguments with empirical evidence and examples.
Logical connectors like "therefore" were used to link ideas and build the argument. The plan laid out a logical argument supported by citing research studies and examples.
The conclusion directly answered the question by summarizing that diagnosis can only be reliable and valid to a limited extent given issues around classification systems, interpretation, bias, and cross-cultural differences.
So in summary, the critical thinking plan demonstrated
This document discusses the difficulties in measuring and defining grief as well as opportunities for grief research. It notes that while grief is a universal experience, it is also uniquely experienced. There is lack of consensus on how to define grief and its various stages or patterns. The document also discusses the evolution of conceptualizing pathological grief and proposes criteria for traumatic grief and prolonged grief disorder. It emphasizes the importance of grief measurements and definitions for diagnosing those in need of treatment and evaluating interventions. Overall, the document argues that while progress has been made, more research is still needed to better understand and measure non-pathological grief and identify factors that contribute to progress and growth following bereavement.
The document discusses the clinical interview, which is a major tool used by clinical psychologists to gather data and make decisions. It defines the clinical interview and describes its importance. Several types of interviews are covered, including intake interviews to understand a patient's symptoms, case history interviews to obtain background information, mental status examinations to assess psychological functioning, crisis interviews for emergency situations, diagnostic interviews to determine appropriate treatment, and structured interviews with standardized questions. The document also addresses reliability and validity considerations for clinical interviews.
Therapeutic communication techniques are essential for collecting patient information and building rapport. These include using open-ended questions to gather details, active listening skills like restatement and reflection, and observing nonverbal cues. The medical assistant prepares for and assists with the physical exam by setting up supplies, positioning the patient appropriately, and ensuring comfort. The exam follows a head-to-toe sequence and incorporates inspection, auscultation, and other objective assessment methods. Maintaining patient privacy, confidentiality, and centered care are important legal and ethical duties of medical assistants.
Doctor-patient communication has evolved from a paternalistic model to one emphasizing mutual participation. Effective communication is important for accurate diagnosis, treatment adherence and patient satisfaction. It requires listening skills, managing expectations, and tailoring information to individual patients. While doctors value diagnostic skills most, patients prioritize listening. Shared decision-making is preferred but preferences vary between patients. Qualitative research is needed to fully understand patient satisfaction.
The document summarizes a student's summer research project studying patient perspectives on teamwork in the emergency department. The student administered exit surveys to emergency department patients to assess how perceptions of provider teamwork related to patient satisfaction, confidence in providers, and likelihood of following treatment recommendations. The student hypothesized that patients would be less likely to endorse clear team roles but more likely to perceive providers as enjoying their work and sharing treatment goals. The student also hypothesized that more positive perceptions of teamwork would correlate with higher patient ratings in the areas studied. Preliminary results did not support the first hypothesis but supported associations between teamwork perceptions and patient outcomes as outlined in the second hypothesis.
1) The document discusses how clinician-patient communication can impact health outcomes based on several studies. Effective communication is associated with lower blood pressure, better control of conditions like diabetes, and less pain.
2) However, the findings are mixed and some studies found no relationship between communication and outcomes. There are also conceptual and measurement challenges to determining these relationships.
3) The author proposes several pathways through which communication could theoretically lead to improved health outcomes. Key factors in these pathways include proximal outcomes like medication changes, and intermediate outcomes like treatment adherence between communication and final health outcomes.
Vulnerable populations include groups who may have impaired ability to provide fully informed consent to participate in clinical trials. These include children, pregnant women, prisoners, students/employees, and those with cognitive impairments. Additional protections are required when including such groups in research. For children, assent from the child and permission from parents/guardians is needed. Research involving pregnant women or fetuses generally requires the mother's consent and may require the father's consent depending on the study's risks and benefits. Prisoners can only be in research related to their incarceration or behavior with minimal risk. Cognitively impaired individuals may require consent from a legally authorized representative. Researchers must consider risks unique to vulnerable populations and implement safeguards to
Preparation For Oral Exam In Family Medicinemeeqat453
This document outlines the areas that will be assessed in an oral examination for Family Medicine. It discusses 20 different topics that may be covered, including problem definition, management of chronic diseases and psychological problems, preventive medicine, communication skills, ethics, prescribing, referring, compliance, file management, safety, education, and community medicine concepts. Candidates should be prepared to discuss these topics and provide case examples to demonstrate their knowledge and clinical reasoning abilities.
How to form a clinical question. cincinnati childrensCatherineMiller2
This document provides a tutorial on how to form an answerable clinical question in 5 steps: 1) Ask, 2) Acquire, 3) Appraise, 4) Apply, 5) Assess. It discusses using the PICO (Patient, Intervention, Comparison, Outcome) model to develop a well-built clinical question and identifies the type of clinical question and best study design. Clinical scenarios are presented and answered in PICO format to demonstrate how to apply this process. Additional training opportunities in evidence-based care are listed.
1) Psychological assessment plays an important role in cancer care, as psychological factors can interfere with coping, impact risk perception, and preferences for treatment information.
2) Nurses are well-positioned to screen for psychological distress using tools like the distress thermometer, and discuss high distress scores with the interdisciplinary team to determine if further evaluation or intervention is needed.
3) A systematic approach to psychological assessment involves multiple steps from screening to in-depth evaluation and referral for treatment when needed, and has been shown to be feasible in clinical practice.
This document discusses diagnostic classification, descriptive assessment, treatment planning, and prediction in clinical psychology. It describes how diagnostic classification is not the only goal and defines abnormal behavior. Descriptive assessment pays attention to client assets and adaptation. Treatment planning addresses finding the most effective treatment for each individual case. Prediction involves prognosis, future performance, and dangerousness.
The document discusses several variables that can affect the outcomes of psychotherapy. It describes how psychotherapy requires motivation from patients and can be challenging, noting factors like a patient's level of distress, age, intelligence, and openness to the process. Gender is also mentioned as a variable, with questions around whether outcomes differ for male and female patients or if sexism influences therapy. The document aims to outline patient characteristics and variables in traditional therapies that can relate to treatment outcomes.
Is the ability to access, assess and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
This document discusses developing PICO questions to help formulate clinical questions. It provides background on distinguishing background and foreground questions. The PICO framework is introduced as a method to structure clinical questions into four components: P (patient/population), I (intervention), C (comparison), and O (outcome). Examples are provided to demonstrate how to formulate a PICO question from a clinical scenario. The question types that can be addressed through PICO questions are also outlined.
A structured approach for patient consultancy providing guideline to conduct a patient consultancy session in clinical, hospital, retail settings or anywhere else patients are getting consult.
Zackary Berger gave a seminar discussing patient autonomy in theory and practice. He explained that while autonomy is viewed as important in principle, in reality patients do not always exercise full decision-making control. Berger presented research finding that doctors do not typically elicit patient concerns or collaboratively set visit agendas. For hospitalized patients, communication is often poor with plans changing without patient input. Berger concluded that educating doctors and encouraging relational autonomy could help promote patient participation in their own care.
ICCH 2011--Agenda-setting in Routine Ambulatory Encounters: Zackary Berger
Background: Although studies have demonstrated that physicians often fail to elicit the full spectrum of patient concerns, few studies have described the ways in which physicians elicit concerns and the extent to which they set an explicit agenda.
Methods: We performed a qualitative analysis of audio recorded, transcribed routine patient-provider encounters from the Enhancing Communication and HIV Outcomes (ECHO) Study. We developed themes related to whether and how providers elicit patient concerns and then set an agenda for the visit. We developed a coding scheme that we applied to a random selection of 2 encounters per provider (33 providers, 66 encounters total).
Findings: In 41/66 encounters, providers opened the visit with a general question (“How are you doing?”). Seven visits opened with a leading question (“Everything’s okay?”) and 1 with the provider explicitly asking which concerns s/the patient wanted to discuss. Patients more often responded to these opening questions with brief positive statements (“Fine”, n=30) than with actual concerns (n=14). In 12 encounters (18%), the provider continued to elicit concerns until the patient stated that s/he had no further concerns (probe to exhaustion). In 30 encounters, there was no agenda statement. When an agenda statement was made, it most often (n=20) centered on physicians’ priorities. Rarely, there was an agenda statement made by the patient (n=3) or one that was collaboratively negotiated (n=3). In 53% of encounters (n=35), patients brought up new concerns later in their visit.
Implications: Providers frequently use generic opening questions that may not be effective in eliciting patients’ concerns, and then do not continue to elicit further concerns. Negotiation of the visit agenda is rare, and new concerns continue to arise later in most encounters. Providers need further training to more effectively invest in the beginning of each encounter.
Word Count 293
KEY WORDS HIV - communication - decision-making preferences
This document discusses values-based practice (VBP) in clinical decision making. It provides the story of the author's 94-year old aunt who was hospitalized for pneumonia and the challenges in determining her care plan. The document then outlines the key principles of VBP, which includes incorporating both scientific evidence and patient/family values and preferences. It emphasizes using communication strategies like shared decision making to develop optimal care plans that account for both medical and personal perspectives.
A short sharing on doctor-patient communication to First year medical students in Universiti Malaysia Sarawak, to be supplemented with anecdotal accounts.
This document discusses effective doctor-patient communication. It emphasizes the importance of listening to patients, understanding their perspectives, and engaging them as partners in their care. Specific communication skills are outlined, including making eye contact, focusing attention, interpreting patients' messages, gathering information respectfully, and explaining diagnoses and treatment plans. The document also provides guidance on breaking bad news sensitively, showing empathy, and addressing cultural and language barriers to ensure patients feel heard, informed, and empowered. The overarching goal of these techniques is to establish trust and improve health outcomes through comprehensive, patient-centered care.
Zackary Berger gave a seminar on encouraging patient autonomy in practice. He discussed how patient autonomy is viewed in theory as patients evaluating treatment options based on their own values, but in reality patients often do not feel able to make autonomous decisions. The study examined how physicians elicit patient concerns in HIV clinic visits. It found that generic opening questions did not effectively elicit concerns, and physicians did not typically probe further after patients responded that they were "fine". When setting visit agendas, physicians often directed the agenda rather than exploring patient priorities.
Essay plan for "To what extent can diagnosis be reliable and valid?"LauraSw
Yes, the title "To what extent can diagnosis be reliable and valid?" was referred to throughout the plan by discussing how diagnosis can only be reliable and valid to a limited extent.
The critical thinking was well integrated by discussing limitations and issues around reliability and validity of diagnosis and supporting the arguments with empirical evidence and examples.
Logical connectors like "therefore" were used to link ideas and build the argument. The plan laid out a logical argument supported by citing research studies and examples.
The conclusion directly answered the question by summarizing that diagnosis can only be reliable and valid to a limited extent given issues around classification systems, interpretation, bias, and cross-cultural differences.
So in summary, the critical thinking plan demonstrated
This document discusses the difficulties in measuring and defining grief as well as opportunities for grief research. It notes that while grief is a universal experience, it is also uniquely experienced. There is lack of consensus on how to define grief and its various stages or patterns. The document also discusses the evolution of conceptualizing pathological grief and proposes criteria for traumatic grief and prolonged grief disorder. It emphasizes the importance of grief measurements and definitions for diagnosing those in need of treatment and evaluating interventions. Overall, the document argues that while progress has been made, more research is still needed to better understand and measure non-pathological grief and identify factors that contribute to progress and growth following bereavement.
The document discusses the clinical interview, which is a major tool used by clinical psychologists to gather data and make decisions. It defines the clinical interview and describes its importance. Several types of interviews are covered, including intake interviews to understand a patient's symptoms, case history interviews to obtain background information, mental status examinations to assess psychological functioning, crisis interviews for emergency situations, diagnostic interviews to determine appropriate treatment, and structured interviews with standardized questions. The document also addresses reliability and validity considerations for clinical interviews.
Therapeutic communication techniques are essential for collecting patient information and building rapport. These include using open-ended questions to gather details, active listening skills like restatement and reflection, and observing nonverbal cues. The medical assistant prepares for and assists with the physical exam by setting up supplies, positioning the patient appropriately, and ensuring comfort. The exam follows a head-to-toe sequence and incorporates inspection, auscultation, and other objective assessment methods. Maintaining patient privacy, confidentiality, and centered care are important legal and ethical duties of medical assistants.
Doctor-patient communication has evolved from a paternalistic model to one emphasizing mutual participation. Effective communication is important for accurate diagnosis, treatment adherence and patient satisfaction. It requires listening skills, managing expectations, and tailoring information to individual patients. While doctors value diagnostic skills most, patients prioritize listening. Shared decision-making is preferred but preferences vary between patients. Qualitative research is needed to fully understand patient satisfaction.
The document summarizes a student's summer research project studying patient perspectives on teamwork in the emergency department. The student administered exit surveys to emergency department patients to assess how perceptions of provider teamwork related to patient satisfaction, confidence in providers, and likelihood of following treatment recommendations. The student hypothesized that patients would be less likely to endorse clear team roles but more likely to perceive providers as enjoying their work and sharing treatment goals. The student also hypothesized that more positive perceptions of teamwork would correlate with higher patient ratings in the areas studied. Preliminary results did not support the first hypothesis but supported associations between teamwork perceptions and patient outcomes as outlined in the second hypothesis.
1) The document discusses how clinician-patient communication can impact health outcomes based on several studies. Effective communication is associated with lower blood pressure, better control of conditions like diabetes, and less pain.
2) However, the findings are mixed and some studies found no relationship between communication and outcomes. There are also conceptual and measurement challenges to determining these relationships.
3) The author proposes several pathways through which communication could theoretically lead to improved health outcomes. Key factors in these pathways include proximal outcomes like medication changes, and intermediate outcomes like treatment adherence between communication and final health outcomes.
Vulnerable populations include groups who may have impaired ability to provide fully informed consent to participate in clinical trials. These include children, pregnant women, prisoners, students/employees, and those with cognitive impairments. Additional protections are required when including such groups in research. For children, assent from the child and permission from parents/guardians is needed. Research involving pregnant women or fetuses generally requires the mother's consent and may require the father's consent depending on the study's risks and benefits. Prisoners can only be in research related to their incarceration or behavior with minimal risk. Cognitively impaired individuals may require consent from a legally authorized representative. Researchers must consider risks unique to vulnerable populations and implement safeguards to
Preparation For Oral Exam In Family Medicinemeeqat453
This document outlines the areas that will be assessed in an oral examination for Family Medicine. It discusses 20 different topics that may be covered, including problem definition, management of chronic diseases and psychological problems, preventive medicine, communication skills, ethics, prescribing, referring, compliance, file management, safety, education, and community medicine concepts. Candidates should be prepared to discuss these topics and provide case examples to demonstrate their knowledge and clinical reasoning abilities.
How to form a clinical question. cincinnati childrensCatherineMiller2
This document provides a tutorial on how to form an answerable clinical question in 5 steps: 1) Ask, 2) Acquire, 3) Appraise, 4) Apply, 5) Assess. It discusses using the PICO (Patient, Intervention, Comparison, Outcome) model to develop a well-built clinical question and identifies the type of clinical question and best study design. Clinical scenarios are presented and answered in PICO format to demonstrate how to apply this process. Additional training opportunities in evidence-based care are listed.
1) Psychological assessment plays an important role in cancer care, as psychological factors can interfere with coping, impact risk perception, and preferences for treatment information.
2) Nurses are well-positioned to screen for psychological distress using tools like the distress thermometer, and discuss high distress scores with the interdisciplinary team to determine if further evaluation or intervention is needed.
3) A systematic approach to psychological assessment involves multiple steps from screening to in-depth evaluation and referral for treatment when needed, and has been shown to be feasible in clinical practice.
This document discusses diagnostic classification, descriptive assessment, treatment planning, and prediction in clinical psychology. It describes how diagnostic classification is not the only goal and defines abnormal behavior. Descriptive assessment pays attention to client assets and adaptation. Treatment planning addresses finding the most effective treatment for each individual case. Prediction involves prognosis, future performance, and dangerousness.
The document discusses several variables that can affect the outcomes of psychotherapy. It describes how psychotherapy requires motivation from patients and can be challenging, noting factors like a patient's level of distress, age, intelligence, and openness to the process. Gender is also mentioned as a variable, with questions around whether outcomes differ for male and female patients or if sexism influences therapy. The document aims to outline patient characteristics and variables in traditional therapies that can relate to treatment outcomes.
Is the ability to access, assess and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
This document discusses developing PICO questions to help formulate clinical questions. It provides background on distinguishing background and foreground questions. The PICO framework is introduced as a method to structure clinical questions into four components: P (patient/population), I (intervention), C (comparison), and O (outcome). Examples are provided to demonstrate how to formulate a PICO question from a clinical scenario. The question types that can be addressed through PICO questions are also outlined.
A structured approach for patient consultancy providing guideline to conduct a patient consultancy session in clinical, hospital, retail settings or anywhere else patients are getting consult.
Zackary Berger gave a seminar discussing patient autonomy in theory and practice. He explained that while autonomy is viewed as important in principle, in reality patients do not always exercise full decision-making control. Berger presented research finding that doctors do not typically elicit patient concerns or collaboratively set visit agendas. For hospitalized patients, communication is often poor with plans changing without patient input. Berger concluded that educating doctors and encouraging relational autonomy could help promote patient participation in their own care.
ICCH 2011--Agenda-setting in Routine Ambulatory Encounters: Zackary Berger
Background: Although studies have demonstrated that physicians often fail to elicit the full spectrum of patient concerns, few studies have described the ways in which physicians elicit concerns and the extent to which they set an explicit agenda.
Methods: We performed a qualitative analysis of audio recorded, transcribed routine patient-provider encounters from the Enhancing Communication and HIV Outcomes (ECHO) Study. We developed themes related to whether and how providers elicit patient concerns and then set an agenda for the visit. We developed a coding scheme that we applied to a random selection of 2 encounters per provider (33 providers, 66 encounters total).
Findings: In 41/66 encounters, providers opened the visit with a general question (“How are you doing?”). Seven visits opened with a leading question (“Everything’s okay?”) and 1 with the provider explicitly asking which concerns s/the patient wanted to discuss. Patients more often responded to these opening questions with brief positive statements (“Fine”, n=30) than with actual concerns (n=14). In 12 encounters (18%), the provider continued to elicit concerns until the patient stated that s/he had no further concerns (probe to exhaustion). In 30 encounters, there was no agenda statement. When an agenda statement was made, it most often (n=20) centered on physicians’ priorities. Rarely, there was an agenda statement made by the patient (n=3) or one that was collaboratively negotiated (n=3). In 53% of encounters (n=35), patients brought up new concerns later in their visit.
Implications: Providers frequently use generic opening questions that may not be effective in eliciting patients’ concerns, and then do not continue to elicit further concerns. Negotiation of the visit agenda is rare, and new concerns continue to arise later in most encounters. Providers need further training to more effectively invest in the beginning of each encounter.
Word Count 293
KEY WORDS HIV - communication - decision-making preferences
This document provides an introduction to evidence-based medicine (EBM). It discusses how EBM involves integrating the best research evidence, clinical expertise, and patient values. The key components of EBM are asking focused clinical questions, acquiring evidence to answer those questions, appraising the quality of the evidence, and applying the evidence to patient care. The document outlines the different levels of evidence from randomized controlled trials to case reports. It emphasizes that clinical evidence is rapidly increasing and clinicians need skills to efficiently search for and apply the best up-to-date evidence.
This document discusses the doctor-patient relationship and outlines different types of relationships. It notes that traditionally the relationship has been paternalistic, with the doctor in control and the patient submissive. However, there is a shift toward relationships with shared control and mutuality. The document also examines barriers to effective communication from both the doctor and patient perspectives and provides recommendations for developing a better relationship through openness, active listening, and empowering patients.
This document provides guidance on effective patient interviewing skills for physicians. It discusses the importance of professionalism, ethics, using a biopsychosocial model, and patient-centered care. The four core ethical principles are autonomy, beneficence, non-maleficence, and justice. Effective communication involves actively listening, establishing rapport, asking open-ended questions to understand the patient's perspective, and using closed-ended questions to obtain specific details. The goal is to collaborate with patients to understand their health issues and concerns in a holistic manner.
Tucson Medical Center - Guidelines for teaching EBM in your practiceTucsonMedicalCenter
Ryan is a first-year resident who presents clinical cases to his attending physician, Dr. Waters, without thoroughly researching the medical literature. When asked about his research process, Ryan replies that he primarily uses UpToDate, which Dr. Waters feels lacks depth. To encourage Ryan to become a more self-directed learner, Dr. Waters could have Ryan identify his own learning needs, develop a plan to address them, and review the outcomes, following the self-directed learning process. Dr. Waters could also role model searching medical literature and emphasize evidence-based medicine principles to help Ryan frame answerable clinical questions and critically appraise the evidence.
Tucson Medical Center Faculty Edu PPT #7 - Guidelines for teaching EBM in you...TucsonMedicalCenter
Ryan is a first-year resident who presents clinical cases to his attending physician, Dr. Waters, without thoroughly researching the medical literature. When asked about his research process, Ryan replies that he primarily uses UpToDate, which Dr. Waters feels lacks depth. To encourage Ryan to become a more self-directed learner, Dr. Waters could have Ryan identify his own learning needs, develop a research plan, and review outcomes - the key steps of self-directed learning. Dr. Waters could also emphasize incorporating principles of evidence-based medicine to critically evaluate sources and frame answerable clinical questions.
evidence based practice that hlps in you reasarch and ease you in reaseach practice. in this presentation many things are given which you learn n your research article.
Assessing and reporting outcomes that are important to patients in trials and...cmaverga
The document discusses the importance of including patient-reported outcomes (PROs) in clinical trials and Cochrane reviews. PROs are any reports coming directly from patients about how they function or feel in relation to their health condition or treatment, without interpretation by clinicians. It is important to include PROs because they capture effects only known to patients, like symptoms, function, and feelings. The document provides examples of PROs being incorporated into Cochrane reviews and identifies some of the methodological challenges in doing so.
Is respecting patient autonomy enough or must we promote patient autonomy as ...Mark Sullivan
In this presentation, I examine the duty to respect patient autonomy through the requirement for informed consent. I argue that this is inadequate for outpatients with chronic disease. In these patients, we must also promote patient autonomy, understood broadly as the capacity to do and be things of value, for this is the core of the health that is the goal of care.
Evidence based practice in physiotherapy.pptxDrNamrataMane
The document discusses evidence-based practice (EBP) in physical therapy. It defines EBP as integrating the best research evidence, clinical expertise, and patient values and describes the 5 steps of EBP as formulating a question, finding evidence, appraising evidence, implementing evidence, and evaluating outcomes. The document also explores barriers to EBP, such as lack of time and understanding of statistics, and facilitators, like access to online research summaries.
Patient-Centered Communication: A Useful Clinical ReviewZackary Berger
Patient-centered communication is important because of the 5 E's: ethics, emotions, efficiency, effectiveness, and equity. This talk was originally given October 1, 2014, at the Baltimore City Medical Society.
This document discusses the doctor-patient relationship and communication. It covers:
1) The core of medicine is the doctor-patient relationship, with patients expecting both a good relationship and cure. The relationship itself can be part of the therapeutic process.
2) Patients want to trust their doctor's competence, navigate the healthcare system effectively, be treated with dignity and respect, understand how illness/treatment affects their lives, discuss impacts on family/finances, and learn self-care.
3) Effective communication is unique due to the immediate trust and vulnerability patients have with doctors during examinations. Respect, empathy, objectivity, and understanding patient autonomy and values are important.
The document summarizes the doctor-patient relationship. It discusses Parsons' model of the sick and doctor roles, types of relationships like paternalistic and consumerist, influences on the relationship like time pressures and patient characteristics, models of treatment decision making like shared decision making, improving communication skills, and how the relationship has changed from past to present with more emphasis on patient autonomy and mutuality now. The optimal relationship is one of mutual participation and shared decision making.
This document discusses how improving communication between physiotherapists and patients can lead to better clinical outcomes. It provides a model for communication consisting of four habits: investing in the beginning by creating rapport and eliciting patient concerns, eliciting the patient's perspective, demonstrating empathy, and investing in the end by providing information, involving the patient in decision making, and completing the visit. Effective communication satisfies patients' basic psychological needs, facilitates motivation, and improves health outcomes, satisfaction, and the therapeutic relationship for both patients and physiotherapists.
1) Patient-centered care is a philosophy that encourages shared control of medical decisions between the patient and doctor and focuses on treating the whole patient, not just their disease.
2) The concept developed in the 1950s and key components include understanding the patient's experience of illness and social context, finding common ground on treatment goals, and enhancing the patient-doctor relationship.
3) Benefits of patient-centered care include improved patient satisfaction and adherence, better health outcomes, and decreased medical litigation. While it may take more time initially, average visit lengths are not significantly different than conventional care.
Guidelines for Teaching Evidence-Based Medicine in Your PracticeTucsonMedicalCenter
Ryan, a first-year resident, lacks depth in his clinical presentations and relies solely on UpToDate without referencing appropriate medical literature. Dr. Waters encourages Ryan to be more self-directed by following the process of evidence-based medicine (EBM). EBM involves integrating individual clinical expertise with the best external evidence from studies. Dr. Waters can role model EBM for Ryan by completing self-directed learning activities that include formulating answerable clinical questions, efficiently searching medical literature, and critically appraising evidence. Nonadherence to practice guidelines is a major barrier to successfully applying EBM.
The document outlines an introduction to evidence-based medicine (EBM) presented by Judy Tarselli. It begins with an overview of EBM, defining it as the conscientious use of current best evidence in patient care decisions. The presentation then covers the basic steps of EBM, which include forming a clear clinical question, finding the best evidence to answer it, critically appraising the evidence, applying useful evidence in practice, and evaluating the process. It emphasizes that a good clinical question is patient-focused, problem-oriented, and answerable through current literature. The document provides examples to illustrate the key points about EBM.
This document discusses the doctor-patient relationship and communication. It outlines Parsons' model of the sick role and doctor's role, and types of doctor-patient relationships including paternalism, mutuality, consumerism, and default. It covers influences on the relationship like time constraints, patient/doctor characteristics, and structural context. Effective communication skills, health literacy, consent, and partnerships in treatment decision making are also examined. The relationship has evolved from traditional paternalism to emphasize patient-centered care and shared decision making.
This document discusses the doctor-patient relationship and communication. It outlines Parsons' model of the sick role and doctor's role, and types of doctor-patient relationships including paternalism, mutuality, consumerism, and default. It covers influences on the relationship like time constraints, patient/doctor characteristics, and structural context. Effective communication skills, health literacy, consent, and partnerships in treatment decision making are also examined. The relationship has evolved from traditional paternalism to emphasize patient-centered care and shared decision making.
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1. Zackary Berger, MD, PhD
Johns Hopkins School of Medicine
Berman Institute Seminar Series
February 27, 2012
2. Autonomy: uncontroversial in
principle
Standard view (Schneider):
“The physician’s role is to use training etc. to provide
patient with facts…and alternative treatments”
“The patient’s role is to provide the values to evaluate
alternatives and select the one that is best”
2
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
3. …so we can remove impediments
to autonomy and let patients
practice it
“[Once] impediments [to autonomy] are gone, [it is
assumed] people will naturally gather evidence about
the risk and benefits of each medical choice, apply
their values to that evidence, and reach a considered
decision” (Schneider)
3
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
5. How is autonomy exercised in
practice?
“I don’t know anything, how am I supposed to decide?”
“Mandatory autonomy”
We should expect that all patients exercise autonomy
Prophylactic argument
Therapeutic argument
False-consciousness argument
Moral argument (from authenticity)
Not all patients want all autonomy all the time
Various principles must be balanced
“Encouraged autonomy”
Assessing patients’ readiness towards various domains of
autonomy, and encouraging the exercise of preferences
5
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
6. Broader definitions of autonomy
Decisional autonomy
Taking part in medical decision-making
The autonomy to choose autonomy (second-order
autonomy; G. Dworkin)
Relational autonomy
Autonomy is never exercised in isolation
Social support and recognition of the person's status
affect her capacities for self-trust, self-esteem, and self-
respect
…which in turn affect her ability to exercise autonomy
6
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
7. Patients are various
Actual situations can force one to reconsider the
meaning or content of a concept
The thick description of a situation can inform and
modify ethical rules
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
7
8. Encouraging autonomy in clinic and
in the hospital
8
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
9. One aspect of autonomy in the
clinic: setting the agenda
9
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
10. Who controls the conversations?
10
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
12. What is “supposed to” happen?
Allow patient to tell story
Don’t interrupt
Probe to exhaustion – “Is there anything else?”
Set explicit agenda
12
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
13. How do physicians elicit patient
concerns and set an agenda for the
clinic visit?
13
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
14. Study Design, Population, and Setting
Study Design
• Quantitative and qualitative analyses of data from the
Enhancing Communication and HIV Outcomes
(ECHO) Study
Study Population
• 45 HIV providers and 423 patients
Setting
• 4 HIV specialty care sites in Baltimore, Detroit, New
York, Portland
14
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
15. Analysis
Developed themes related to
how the visit is opened
whether and how providers elicit patient concerns
whether and how an agenda is set for the visit
For 3 of 4 sites, coded a random selection of 2
encounters per provider (66 encounters total)
At 4th site (Detroit) a nurse started each visit, thus not
relevant to our aims
15
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
16. Opening of the Visit
Type of Opening Frequency
Total N=66
Example
General Open Question 41 “How are you”
Leading Question 7 “Everything okay?”
Solicitation of
concerns/priorities
1 “Tell me, is there anything that you
wanted to discuss today, in
particular?”
Atypical (no opening
question)
17 --
16
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
17. Patient Response
Type of Response Frequency
Total N=49
Example
General 30 “Fine”
Specific Concern 14 “My legs are hurting me”
Sequence interrupted (no
response)
5 --
17
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
18. Type of Response Frequency
Total N=44
Example
Probing to exhaustion 12 “Is there anything else?”
No further probing 32 --
Further Solicitation of Concerns
18
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
19. Agenda Statements
Type of Agenda
Statement
Frequency
Total N=66
Example
None 40 ---
Physician-directed 20 D: “You’re here because we wanted to
jump on your blood pressure”
Patient-directed 3 P: “So you want to do the blood work
for my CD4 count and viral load. Can
you check me for, um, is there blood
work for diabetes?”).
Collaborative 3 D: “Okay. Anything else goin’ on?”
P: “Uh, not really. I think I’m so
centered on the pain thing that I,
that’s my focal point now”
D: “Well let’s make a priority”
19
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
20. Generic opening questions don’t
solicit concerns
Frequently used by providers
Not effective in eliciting concerns
Physicians do not typically continue to probe further
Patients’ response
suggest that they function as a social exchange rather
than genuine exploration of patient priorities
20
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
21. When the doctor asks “How are
you?”
“When the doctor asks, ‘How are you?’ and you say,
‘Fine,’ the doctor thinks he has gathered clinical facts,
while you think you have been polite.” Mother of a
Child with Cancer (quoted in Lynn J and Harrold J,
Handbook for Mortals: Guidance for People Facing
Serious Illness)
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
21
22. Agendas are not often explicitly
stated
When an agenda is stated, it tends to center on
physicians’ priorities
Negotiation of the visit agenda between patient and
provider is rare
22
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
23. Ways to encourage autonomy in
clinic
Give patients the explicit opportunity to state their
priorities
Discuss (negotiate) with them the agenda for the visit
23
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
24. Setting agenda: recommendations
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012 24
Needed: Interventions to educate physicians and
patients about how to most effectively discuss/express
concerns and set an explicit visit agenda
Physicians ought to be aware that a question such as
‘How are you?” is not always interpreted by the patient
as an opportunity to express their concerns
Patients should be empowered to express their concerns
and negotiate the agenda
25. Autonomy in the hospital:
understanding communication
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
25
27. Autonomy in the hospital:
preliminary work
11% of our sample (5 of 46) could not state their
physicians’ reason for admission
Coronary artery disease (n=1), hypertension (n=2),
sigmoid mass (n=1), and stage IV cholangiocarcinoma
(n=1).
Discordance among patient- and physician-stated
reason for admission was common (37%)
E.g. patient: “Can’t speak”; chart: “Atrial tachycardia”
27
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
28. Patient experience in the hospital:
a study in progress
N=20 patients admitted to the hospitalist service at JHH
Mixed methods study
combination of narrative and conversation analysis (qualitative)
existing communication coding systems (quantitative)
Aims
Characterize communication between physicians and hospital
patients
Determine the exercise of and influences on inpatient autonomy as
determined by their participation in decision-making,
specify the nature of relationships between inpatients and their
physicians
identify opportunities for greater exercise of patient autonomy
through enhanced communication and relationships.
28
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
29. Transcript excerpt 1: Patient’s role
in the plan of care
Research Assistant: And is there anything you think should be done that’s
different from what the doctor said or do you pretty much agree?
Patient: I agree, it’s a shock to me. I didn’t know this was going on but, yes
they need to explain more to patients, that’s anywhere, because I was really
misled from a couple, from one, that’s why I went to different hospitals,
because it seems like they couldn’t tell me what was going on with me, they was
telling me everything but what was going on and, I don’t know.
Research Assistant: Ok, and what about here, since you got here…and
through the emergency room and everything?
Patient: I couldn’t believe they didn’t have pencils for me to write numbers
down. She told me they had to bring their own pencils. And there was only 1
doctor I got into with since I’ve been here and that was a woman. And I told
her she was very cold-hearted, evidently she must not be a mother, or a
grandmother or a child of God because to treat somebody like that that’s
sick, she didn’t know me from Adam and Eve and she just kept telling me
what she had to do by the rules and I was telling her what I’m
experiencing, what I’m feeling and I’m 49 years old.
29
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
30. Transcript excerpt 2: Patient’s role
in the plan of care
Research Assistant: Have there been any changes since we
last spoke about the plan for your care when you’re here.
Patient: Yea. Yesterday they told me I was supposed to get an
MRCP, today they’re telling me they want to give me a CAT
scan. And then a woman doctor came in this morning with
another man and said ‘ok, you’re going to be drinking a
barium solution’ which is what I’ve done in the past.
Third Party (Mom): With the CAT.
Patient: Yes. And then I wake up and everyone in the
world is here, and the doctors say ‘no you’re not going
to drink anything you’re just going to get an
injection.’…I have no idea what they’re talking about.
30
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
31. Transcript excerpt 3: Patient views
of autonomy
Research Assistant: And how do you feel specifically
today about how people, how the doctors are involving you
in decisions?
Patient: Um, I feel like I’m not really involved at all,
unless I say I just want to talk to my specialist and
then everything gets put on pause.
Research Assistant: And do you wish you were a bit more
involved?
Patient: Yea. I mean I wish involved with communication.
Maybe you should start writing stuff down mom. You
know, somebody should start writing stuff down, what they
say.
31
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
32. Conclusion: Encouraging the
exercise of autonomy
Educating housestaff/attendings to recognize
opportunities for empathy (encouraging relational
autonomy)
Creating opportunities for patients to discuss their
second-order preferences
Recognize the variety of patients’ approaches to
decisional autonomy
32
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
33. Acknowledgments
Funders
Osler Center for Clinical Excellence at Johns Hopkins
Greenwall Foundation
Study team
Mary Catherine Beach
Dan Brotman
Heather Dark
Amanda Bertram
Maggie Neely
Physicians, patients, nurses on the hospitalist service
Encouraging Patient Autonomy From Theory to
Practice: Z. Berger, Berman Seminar, 2/27/2012
33