Podcast
Questions and Answers
What are the levels of the health care system?
What are the levels of the health care system?
Teleconsultations can provide timely care that is easily accessible.
Teleconsultations can provide timely care that is easily accessible.
True
What is the main philosophy behind Patient-centered care (PCC)?
What is the main philosophy behind Patient-centered care (PCC)?
Shared consultation and focusing on the patient as a whole
Teleconsultations refer to interactions between a clinician and a patient for providing diagnostic or therapeutic advice using ______.
Teleconsultations refer to interactions between a clinician and a patient for providing diagnostic or therapeutic advice using ______.
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Match the following steps of the patient-centered model with their descriptions:
Match the following steps of the patient-centered model with their descriptions:
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What are the vital signs that reflect the body's physiological state?
What are the vital signs that reflect the body's physiological state?
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Which temperature remains constant most of the time?
Which temperature remains constant most of the time?
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Fever above 41°C is referred to as hyperpyrexia.
Fever above 41°C is referred to as hyperpyrexia.
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A fever with a temperature above normal is known as ____________.
A fever with a temperature above normal is known as ____________.
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Match the following categories of blood pressure in adults with their corresponding values:
Match the following categories of blood pressure in adults with their corresponding values:
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What is the key of cardiovascular risk and often referred to as a silent killer?
What is the key of cardiovascular risk and often referred to as a silent killer?
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What is the best goal for weight loss as a lifestyle measure in treating hypertension?
What is the best goal for weight loss as a lifestyle measure in treating hypertension?
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How much reduction in body weight should be aimed for in most adults who are overweight?
How much reduction in body weight should be aimed for in most adults who are overweight?
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What is the optimal goal for daily dietary sodium intake?
What is the optimal goal for daily dietary sodium intake?
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What is the recommended daily intake range for dietary potassium?
What is the recommended daily intake range for dietary potassium?
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What is the recommended duration of aerobic physical activity per week for treating hypertension?
What is the recommended duration of aerobic physical activity per week for treating hypertension?
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Study Notes
Early Patient Encounter (EPE)
- Practice of medicine is an art based on science
- Good physicians treat the disease, but great physicians treat the patient who has the disease
Levels of Health Care System
- Primary care: provided by physicians trained for and skilled in first contact; provides continuing care for persons with any health concern
- Secondary care: medical care that is provided by specialists upon referral by a primary care physician; requires more specialized knowledge and skill than primary care physician
- Tertiary care: specialized consultative health care; referral from a primary or secondary health professional; has facilities for advanced medical investigation and treatment (e.g., tertiary referral hospital)
Clinical Encounter
- Can occur in clinics, hospitals, emergency departments, or patient's own house during home visits
- Can also occur virtually through teleconsultations
- Teleconsultations: interactions between a clinician and a patient for providing diagnostic or therapeutic advice
- Examples of services that can be done through teleconsultation:
- Providing results of investigations
- Request for sick notes
- Emergency appointment requests
- Health promotion (e.g., promoting smoking cessation services)
- Effective healthcare (e.g., follow-up of depressed or diabetic patients)
Benefits of Teleconsultation
- Convenience for patients (e.g., no time off work)
- Convenience for doctors (e.g., shorter consultation)
- May reduce practice costs (e.g., more doctor time available for other patients)
- Can overcome the issue of a lack of consultation rooms
- Can improve medical access for the disabled
Disadvantages of Teleconsultation
- Absence of non-verbal cues and missed hidden agendas or fears
- No examination findings
- Issues of confidentiality
- Deafness or language can be a big barrier to communication
- Reduced opportunity for health promotion (e.g., blood pressure measurement)
- No opportunity for basic investigations (e.g., pregnancy test or urine dip test)
Teleconsultations in Pandemics
- Safe and effective way to guide the patient's diagnosis and treatment, minimizing the risk of disease transmission
- Enable many clinical services to continue to operate regularly
- Help with management of patients
Patient-Centered Care (PCC)
- Philosophy of care that encourages shared consultation and decisions about management of problems with the patient
- Focuses on the patient as a whole (in contrast to a focus on body part or disease)
- Involves:
- Transforming the relationship between providers and patients from traditional model to a patient-provider partnership
- Treating patient as partners, involving them in planning their healthcare
- Helping the patient become medical decision-makers
The Science of Patient-Centered Care
- Replaces the 'disease-oriented' model with patient's experience of illness, psychosocial aspect, and decision-making with patient and family
- Compares medical (traditional model) and patient-centered model:
- Patient role: passive vs. active
- Focus: disease-centered vs. quality of life-centered
- Recipient of treatment vs. partner in treatment plan
- Compliance vs. following plan
- Dominant decision vs. collaborative decision
Steps of Patient Centered Model
- Exploring both disease and illness
- Disease: abnormality structure, function of body organ/systems including physical and mental disorder
- Illness: how patient feels about being ill, what impact the illness has on patient's function
- Understanding the whole person
- Person's history, personality development
- Finding common ground
- Mutual definition of problems
- Mutual definition of goals of management/treatment
- Prevention and health promotion
- Health enhancement: doctor and patient monitor areas in patient's life that need improvement for long-term physical and emotional health
- Risk reduction and early detection: doctor monitors, recognizes problems, and screens for unrecognized disease
- Patient-doctor relationship
- Every visit develops care and effective long-term relationship
- Being realistic
- Time: manage time for maximum benefit of patient
- Realistic about availability of resources
Research on Patient-Centered Method
- Greater levels of patient satisfaction
- Greater levels of doctor satisfaction
- Better patient adherence
- Higher quality of self-reporting
- Fewer malpractice claims
- Greater physician detection
- Has a positive impact on healthcare utilization costs
Clinical Approach
- Includes:
- History taking
- Examination (general and specific)
- Investigation
- Diagnosis
- Comprehensive management
- Follow-up
- Important for decision-making and providing care to patients
History Taking
- Important skill that is essential for decision-making
- Useful for making diagnosis before performing physical examination
- General approach:
- Introduce yourself
- Great patient in a friendly relaxed way
- Confidentiality and respect patient privacy
- Questioning: simple, clear, open, and leading questions
- Complete history taking:
- Personal history: full name, age, sex, address, marital status, occupation
- Chief complaint: main reason for visiting a physician
- Present history: elaborate on chief complaint in detail
- Past history: asking patient if they have any medical problems
- Family history: previous similar illnesses in the family
- Psycho-social history: smoking, drinking, occupation, education background
Vital Signs
- Reflect body physiological state and provide information to evaluate homeostatic balance
- Include: temperature, pulse rate, respiratory rate, and blood pressure
- Purpose:
- Obtain data about patient condition
- For diagnostic, therapeutic purpose
Taking Vital Signs Accurately
- Precautions:
- Examination room should be quiet and warm
- Take a minute before starting examination
- Look at the patient in their entirety
- Make observations before starting examination
Temperature
- Body temperature: balance between heat production and heat loss
- Stable if heat generated = heat lost
- Normal: 37°C or 98.6°F
- Two kinds of body temperatures:
- Core temperature (temp of internal organ; remains constant most of the time)
- Surface temperature (temp of skin, sub-cutaneous tissue, fat cell; rises or falls in response to environment)
History of Acute Sore Throat
- Acute pharyngitis is one of the most common conditions encountered in outpatient clinical practice
- Most cases of acute pharyngitis are caused by respiratory viruses and are self-limited (lasts for about a week)
Investigation of Acute Sore Throat
- Diagnosis is usually clinical
- Evidence of infection can be gained by measuring changing antibody response (ASO titre)
Center Criteria
- 1 point for each feature:
- Tonsillar exudate
- Tender anterior cervical lymph nodes
- History of fever >38°C
- Absence of cough
Fever PAIN Score
- 1 point for each feature:
- Fever in the previous 24 hours
- Pus on tonsils
- Attends rapidly (e.g., within 1 month)
Referral for Tonsillectomy
-
Recurrent acute tonsillitis that leads to missing a lot of school/work (e.g., >7 attacks/year for 2 years)
-
Airway obstruction: very large tonsils causing sleep apnea
-
Chronic tonsillitis >3 months + halitosis
-
Unilateral tonsillar enlargement or recurrent quinsy### Acute Otitis Media (AOM)
-
Majority of AOM cases resolve spontaneously
-
No need for long-term prophylactic antibiotics in primary care
-
Watchful waiting and observing children for clinical improvement is the appropriate strategy for non-severe AOM
-
Antibiotics should be provided to children if the infection worsens or fails to improve within 24-48 hours
Referral of AOM
- Children with AOM associated with severe systemic infection
- Children with acute complications like meningitis or intracranial abscess
- Recurrent AOM (three or more ear infections in the last six months)
- Impaired hearing following AOM
- Failure of infection to resolve even after taking previous antibiotics
- Persistent perforation
- Neonates, children younger than 3 months of age, or those with a high temperature of 38°C or more
Hypertension
- Persistent elevation of blood pressure: ≥ 140 systolic and/or ≥ 90 diastolic
- Categories of BP in adults:
- Normal BP: < 120 mmHg systolic and < 80 mmHg diastolic
- Elevated BP: 120-129 mmHg systolic and < 80 mmHg diastolic
- Hypertension: stage 1 (130-139 mmHg systolic or 80-89 mmHg diastolic), stage 2 (≥ 140 mmHg systolic or ≥ 90 mmHg diastolic)
- Resistant hypertension: BP above goal despite adherence to a combination of at least 3 optimally dosed antihypertensive medications
- Hypertensive urgency: acute rise in BP without evidence of acute end-organ dysfunction
- Hypertensive emergency: acute rise in BP with acute end-organ dysfunction
- White coat hypertension: BP higher when measured in the medical office than when measured at home
Diagnosing Hypertension
- Clinical presentation:
- Asymptomatic
- End-organ damage
- Secondary cause
- Patient evaluation aims:
- Assess lifestyle and identify other cardiovascular risk
- Reveal identifiable causes of high BP
- Assess target organ damage and CVD
- Clinical examination:
- General examination (BP measurements, weight, and height)
- Cardiac examination (LVH)
- Abdominal examination (renal mass, aortic aneurysm)
- Chest examination
- Neurological examination
- Investigations:
- Basic testing (fasting blood glucose, complete blood count, lipid profile, electrocardiogram, etc.)
- Optional testing (echocardiogram, uric acid, urinary albumin to creatinine ratio, etc.)
Treating Hypertension
- Lifestyle measures:
- Weight loss (aim for ideal body weight, expect about 1 mmHg reduction in BP for every 1 kg reduction in body weight)
- Healthy diet (DASH pattern, diet rich in fruits, vegetables, and grains)
- Reduced intake of sodium (optimal goal ≤ 1500 mg/d, aim at least 1000 mg/d reduction for most adults)
- Enhanced intake of potassium (aim for 3500-5000 mg/d, by consuming a diet rich in potassium)
- Physical activity (at least 90-150 minutes/week of aerobic exercise)
- Moderation in alcohol intake (reduce alcohol to ≤ 2 drinks daily for men, ≤ 1 drink daily for women)
- Pharmacological management:
- Recommendations for choice of initial monotherapy versus initial combination drug therapy
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Description
This quiz covers the levels of the healthcare system, the concept of teleconsultations, and the philosophy behind patient-centered care. It also explores the vital signs that reflect the body's physiological state.
