Term
| Why do you want to be a Doctor? |
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Definition
Ego
Altruism: care about people.
Reward
Modeling
Motivation |
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Term
| Qualities of the Physician |
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Definition
1. Imperturbability
2. Presence of Mind
3. Clear Judgment
4. Ability to Endure Frustration
5. Infinite Patience
6. Charity toward Others
7. Search for Absolute Truth
8. Composure
9.Bravery
10.Tenacity
11.Idealism
12. Equanimity |
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Term
| Would you talk candidly to your physician about your sexual history, your lifestyle, your substance use? |
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Definition
Patients list kindness, understanding, interest and encouragement as primary expectations.
They want their physical, interpersonal and emotional needs met in a mutually understood, courteous, warm and personal manner. |
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Term
| Models of Health Care Prevention |
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Definition
The Traditional Model
The IOM Model (Institute of Medicine) |
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Term
| Traditional Public Health Model |
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Definition
Primary Prevention
Secondary Prevention
Tertiary Prevention |
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Term
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Definition
Practices to protect, promote and maintain health and preventing the development of problems.
Exercising regularly
Maintaining normal weight
Eating nutritional foods
Learning about health
Learning how to cope
Some Behavioral Primary Prevention Programs
Education about health
Safety training
Violence prevention
Safe Sex practices |
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Term
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Definition
Practices that enhance resistance to disease:
Targeted Immunizations
Medical Screening
Early Intervention
Reduction of pre-disposing factors
Some Behavioral Secondary Prevention Programs:
School Screening Programs for Risk
Self-Help Groups for problems
Prenatal (occurring or existing before birth) and Perinatal (occurring during the period around birth (5 months before and 1 month after) Education |
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Term
| Current IOM Terminology : Approaches to ''Prevention'' |
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Definition
Universal :Target whole populations at average risk. (The warning sign on bottles of alcohol about risk to pregnancy).
Selective: Target specific groups at increased risk. (don't let pregnant women drink).
Indicated: Target those individuals at highest risk. (Counseling and treatment for women who are pregnant and are drinking). |
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Term
| The IOM Mental Health Intervention Spectrum |
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Definition
Prevention: (Universal, Selective, Indicated)
Treatment
Maintenance |
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Term
| Leading source of Risk and DALYs. |
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Definition
| Mental Health Issues: assess of the mental and behavioral health of your patient is as important as the assessment of physical health. |
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Term
| Deaths attributed to low country income level |
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Definition
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Term
| Attributable Mortality (Leading factor to Deaths) |
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Definition
| High Blood Pressure and Tobacco |
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Term
| Disability Adjusted Life Years (DALYs) |
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Definition
| "lost years of healthy life" regardless of whether the years were lost to premature death or disability. |
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Term
| Attributable DALYs (Disability Adjusted Life Years) |
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Definition
| Childhood underweight and "Unsafe Sex" |
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Term
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Definition
1. "High blood pressure" is the leading risk factor for mortality, responsible for 13% of deaths globally
2. "Childhood underweight" is the leading risk factor for burden of disease and is responsible for over 2 million children dying per year, mainly in low-income countries
3. "Environmental risks" such as unsafe water, sanitation and hygiene and indoor smoke from solid fuels cause around 2 million children deaths per year
4. "Low fruit and vegetable intake, lack of exercise, alcohol and tobacco use, high body mass index, high cholesterol, high blood glucose, and high blood pressure" are risk factors responsible for "more than half of the deaths due to heart disease", the leading cause of death in the world. |
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Term
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Definition
5. “Unsafe sex”, which leads to transmission of “human papilloma-virus”, is responsible for virtually “all deaths due to cervical cancer”. “Cervical cancer is responsible for 11 percent of global unsafe sex deaths” and is the “leading cause of cancer death in Africa”.
6. “Tobacco” is a “leading risk factor for mortality”, responsible for 5.1 million deaths. Almost “1 in 8 deaths of adults over the age of 30” is due to smoking.
7. “Being overweight or suffering from obesity” is the “fifth leading risk for death”. It responsible for 7 per cent of deaths globally - 8 per cent in high income countries and 7 per cent in middle income countries. |
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Term
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Definition
| Any severe mental disorder in which contact with reality is lost or highly distorted. Produces disability equal to quadriplegia (paralysis of both arms and both legs). |
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Term
| "Psychiatric disorders" contributing significantly to DALYs |
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Definition
1. Schizophrenia (A psychotic disorder or disorders marked by some or all of these symptoms: delusions, hallucinations, disorganized and incoherent speech, severe emotional abnormalities, and withdrawal into an inner world).
2. Bipolar disorder
3. Obsessive-compulsive disorder
4. Panic disorder
5. Post-traumatic stress disorder |
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Term
| “Disease Burden” in the Established Market Economies |
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Definition
Unipolar Major Depression 6.8
(Not able to live their lives).
Alcohol Use 4.7 |
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Term
Why do we emphasize
Patient-Centered Care? |
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Definition
To Find it and Fix it we need the Patient’s involvement!
To assess the patient’s HISTORY including needs, lifestyle, beliefs and other factors so that we can assess "RISK" and assess the patient’s "READINESS FOR CHANGE". |
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Term
| "Common Human Behaviors" that Endanger Good Health |
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Definition
Reckless Driving
Excessive Alcohol Consumption
Illegal Substance Consumption
Unprotected Sexual Encounters
Over-eating or Anorexia
Lack of Anger Control
Lack of Impulse Control
Abuse – physical, emotional, financial
Poor nutrition
Inadequate prenatal and perinatal care
Lack of education and inability to read |
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Term
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Definition
What is the behavior in each?
1. Tobacco
2. Poor Diet and Physical Inactivity
3. Alcohol Consumption
4. Sexual Behavior
5. Drug use |
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Term
| Adherence: A great balance. |
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Definition
Physician takes the time to understand the patient and helps the patient understand the recommendations.
Patient tells the physician needed information and follows physician recommendations Thus the patient feels heard and understood. |
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Term
Establishing Rapport
with your Patient. |
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Definition
1. Create an atmosphere of "Caring"
2. Empathy
3. "Inform" your patient of what you intend to do.
4. "Nonjudgmental"
5. "Be honest"
6. Pay attention to your patient's "feelings and behavior"
7. Be aware of patient's "belief systems and habits"
8. "Actively Listen"!!! |
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Term
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Definition
Empathy is understanding the patient’s experience.
Sympathy is feeling and experiencing the emotions expressed by the patient. |
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Term
| Factors that Increase Adherence |
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Definition
Patient factors:
If the patient is feeling very sick
Limitation of usual activities by the patient
Sudden onset of an illness
Peer (or family) support to comply
Physician factors:
Providing simple treatment schedules
Providing written instructions for taking medicine
A short time spent in the waiting room
Recommending one behavioral change at a time
Remaining empathetic and non-judgmental
LISTENING TO THE PATIENT |
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Term
Adherence with Medical Advice
Is NOT related to and related |
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Definition
ESPECIALLY related to:
"How well the patient likes the Doctor".
Is NOT related to:
1. Patient intelligence
2. Education
3. Sex
4. Religion
5. Race
6. Socioeconomic status
7. Marital Status
IS related to:
1. Patient Personality traits
2. Patient Defense Mechanisms |
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Term
| Model of Complete Clinical Care |
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Definition
Communication Tasks
The “E’s”
Biomedical Tasks
The “F’s” |
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Term
| Communication Tasks, The “E’s” (Patient Centered Comprehensive Care) |
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Definition
1. Engage
2. Empathize
3. Educate
4. Enlist |
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Term
| Biomedical Tasks, The “F’s” (Doctor Centered Comprehensive Care) |
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Definition
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Term
Interviewing Steps 1-5
Advanced interviewing |
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Definition
1. setting the stage
2. agenda setting
3. opening the history of the present illness (HPI)
4. continuing the HPI
5. transition to Doctor-centered questions
Asking many questions which are gathered "selectively" according to what the patient is expressing, while "focusing on patient concerns".
Adapting to the clinical scenario that is in front of you. |
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Term
| SO HOW MUCH TIME DO I SPEND WITH A PATIENT? |
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Definition
Clinical Scenarios
1. New patient without urgent action required or complex personal problems.
2. New patient with urgent actions required or complex personal problems.
3. Follow-up with a patient without urgent action required or complex personal problems.
4. Follow-up with a patient with urgent action required or complex personal problems.
5. Disease prevention (Routine) visit that focuses on motivational change, maintenance and/or health promotion.
6. Disease prevention visit that focuses on investigation of health hazards and follows with motivational change.
7. Addressing predominately psychological problems. |
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Term
| "I hate having my breasts squashed, it's uncomfortable". What would influence her to agree to a mammography? |
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Definition
-Offer her analgesia prior to the mammogram.
Solve the Problem! Don't add anything. If it looks like a duct, it's a duck. Don't use scare tactics, and listen to the patient. |
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