Topnotch Medical Board Prep Preventive Medicine and Public Health - April 2024 PDF

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch sin...

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. • Level 4 – systematic family assessment and planned intervention o Family Systems Theory o MD should be skilled enough to assess family functions and carryout short-term family-level interventions • Level 5 – Family therapy o Planning an organized therapeutic approach to bring out major changes in the family system The most appropriate degree of physician involvement remains at Level 2 and 3 Dr. de la Rosa FAMILY SYSTEMS THEORY • Defines the family as a continuous interlocking human relationship, organized in such a way that when there is a change in one family member, the other family members are affected. o The family is more than a collection of individuals o Have repeating interaction patterns that regulate member behavior o An individual symptom may have a function within the family o The ability to adapt to change is the hallmark of healthy family functioning o There are no victims and victimizers in families SUPPLEMENT: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 End poverty in all its forms everywhere End hunger, achieve food security and improved nutrition and promote sustainable agriculture Ensure healthy lives and promote well-being for all at all ages Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all Achieve gender equality and empower all women and girls Ensure availability and sustainable management of water and sanitation for all Ensure access to affordable, reliable, sustainable, and modern energy for all Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation Reduce inequality within and among countries Make cities and human settlements inclusive, safe, resilient and sustainable Ensure sustainable consumption and production patterns Take urgent action to combat climate change and its impacts Conserve and sustainably use the oceans, seas and marine resources for sustainable development Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable, and inclusive institutions at all levels Strengthen the means of implementation and revitalize the global partnership for sustainable development BASIC FAMILY MEDICINE CONCEPTS AND PRINCIPLES ACTIVE LISTENING SKILLS • • • • • • Mnemonic: ABLe-ReP Attending Bracketing Leading Reflecting content, feeling, experience Probing PHYSICIAN’S LEVEL OF FAMILY INVOLVEMENT • Level 1 – Medical advice (minimal emphasis on the family) o Focuses on the biomedical problem o Individual interventions limited to advice on medico-legal issues • Level 2 – providing ongoing medical information and advise o Triangular nature of the doctor-patient-family considered o Respectful listening is done, but no intervention is involved on the family • Level 3 – eliciting feelings and providing emotional support o health education and emotional / psychosocial support – where active listening skills come to play o response to emotional needs of family members o requires understanding of normal family development and responses to stress ATTENDING • Non-verbally saying that “I am listening to you” / “I am paying attention” • Mnemonic: LOVERS o Leaning foreword o Open stance o Voice of empathy / compassion o Eye contact o Relaxed setting o Sit at an angle (45°) BRACKETING • A mental skill more than a non-verbal skill • Setting aside our biases, prejudices, and pre-conceived notions to make way for what the patient is really saying In short, bawal judgemental hehe Dr. de la Rosa LEADING DIRECT • Requires a judgement call from the physician to guide the conversation into the direction that will give the important information • No new material introduced Ang pagkukunan mo ng information ay kung ano lang ang sinabi ng pasyente. Wala kang iintroduce na bagong concept. INDIRECT • open invitation to talk about anything he wishes Ex. Anong maipaglilingkod ko sa inyo? Ano po ang isinasangguni ninyo ngayon? • Can also be words or phrases that prompt the patient to continue talking Dr. de la Rosa REFLECTING CONTENT, FEELING, AND EXPERIENCE REFLECTING CONTENT PARAPHRASING • Uses fewer and clearer words to summarize what was said • One must be careful to capture completely the essence of what the patient is trying to say • One must also be careful not to add to the paraphrase anything which the patient has not mentioned. PERCEPTION-CHECKING • Used when doctor is not certain if he understood what was said • Similar to paraphrasing but is an interrogative statement TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 66 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. REFLECTING FEELING • articulate the feeling for the patient, especially when patient is unable to express or describe his emotions • serves several therapeutic purposes: o by naming the feeling, patient becomes more aware of the emotion and may reveal the perception behind the feeling o allows emotional catharsis and provides relief o accurately reflected feelings improves patient rapport REFLECTING EXPERIENCE • Verbalizing of nonverbal cues given by the patient • These nonverbal cues are unconscious and are valuable clues as to what the emotions of the patient are PROBING • Probes are questions that are asked in order to elicit more information and doctors are usually very good a probing for clinical detail. o How does that make you feel? o Can you tell me more about that feeling? o What is it that makes you feel that way the most? • Invites people to talk about their feelings and may also provide catharsis FORMS OF COMMUNICATION • Verbal Communication • Non-verbal Communication o Eye contact – indicates sincerity. Staring continuously might threaten your patient o Mannerisms – it might distract the patient during history taking o Touch – connotes an establish a sense of personal relationship with the patient o Gesture- should be done with ease so that it appears spontaneous and avoid distractions o Tone of voice – should be modulated o Posture – leaning forward – interested, leaning backward – not interested. • Symbolic Communication o Includes external manifestations of both physician and patient (hairstyle, dressing, social distance) SUPPLEMENT: o THE FAMILY AS UNIT OF CARE WHAT IS A FAMILY? • Classic textbook definition – group of two or more persons related by birth, marriage, adoption, or emotional ties residing together in a single household • Anthropologic viewpoint – biological and marital kinship rules and patterns of reciprocal obligation • Biologic viewpoint – genetic transmission unit • Sociologic viewpoint – enduring social form in which a person is incorporated • Psychologic viewpoint – matrix of personality development and the most intimate emotional unit of society ESSENTIAL FUNCTIONS OF FAMILIES (ZIMMERMAN) Schlesinger, 1988 • Physical maintenance and care of family members • Addition of new members (procreation / adoption) and release from family once of age • Socialization of children for adult roles • Social control of members: maintenance. of order • Maintenance of family morale and motivation • Production and consumption of goods and services FIVE BASIC FUNCTIONS OF A FAMILY • Provide support for each other • Establish autonomy and independence which enhance personal growth of individuals within the family • Create rules that govern the conduct of the family and of the individuals within the family • Adapt to change in the environment • Communicate with each other CHARACTERISTICS THAT DELINEATE FAMILY FUNCTIONING • Interdependence o There is individuality and a high degree of differentiation o Rules are clear and reasonable o Good communication o Authority or power is clearly vested in individuals as agreed upon by the family members o Tasks and chores are shared • Maintenance of boundaries o Role distinctions are clear with distinct boundaries o Respect for individual differences in energy levels, perception of time, and space requirements • Exchange of energy with the environment o Natural development of high esteem both for the individual and the family o A full range of emotions is acceptable, appropriate, and encouraged • Adaptive o Conflicts are resolved through bargaining and negotiation, with all family members able to participate CHARACTERISTICS OF A FILIPINO FAMILY • Closely knit • Unilaterally or Bilaterally extended (or live near each other) • Strong family orientation • Authority is based on seniority / age • Externally patriarchal / internally matriarchal • High value on education of members • Predominantly Catholic (80% population) • Child-centered • Average number of members is 5 (NEDA statistics) • Environmental stresses: economic, political, urbanization and industrialization, health problems This is an outdated but still testable concept. General idea na lang siya of a Filipino Family but due to the changing times, some of these may not be true or acceptable anymore J Dr. de la Rosa FAMILY TYPES ON BASIS OF SIZE AND STRUCTURE • NUCLEAR o Consists of parents and their still dependent children o Includes married couples (or divorced or widowed parent) with unmarried children and married couple without children o SINGLE PARENT FAMILY § Children <17yrs, living with family with single parent, another relative, or a non-relative § Maybe due to loss of spouse by death, divorce, separation, desertion § Out of wedlock birth of a child § From an adoption § OFWs • EXTENDED FAMILY – Unilaterally/Bilaterally extended o Number of nuclear families linked together by virtue of the kinship between parents and children or between siblings o Families of orientation are merged with families of procreation o Lineal vs. Joint § Lineal – Consisting of (2) or more generations with each generation composed of one married couple (or a divorced person, widow, or widower) § Joint – Consisting of (2) or more married couples (or divorced persons, widows, or widowers) of the same generation (siblings) • BLENDED FAMILY – Includes step parents and step children; Caused by annulment with remarriage and separation • COMMUNAL OR CORPORATE FAMILY o Grouping of individuals formed for specific ideological or societal purposes o Considered as an alternative lifestyle for people who feel alienated form the predominantly economically oriented society ON THE BASIS OF AUTHORITY (1) Patriarchal Family: o The family in which all the power remains in the hands of patriarch or father is known as patriarchal family. o This type of family is widely found all over the world TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 67 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. (2) Matriarchal family: o This type of family is just opposite of patriarchal family. o In this family power or authority rests on the eldest female member of the family especially the wife or mother. (3) Egalitarian family: o The family in which power and authority are equally shared between husband and wife is called as egalitarian family. Both take joint decisions or assume joint responsibility. o That is why it is called as equalitarian family. (4) Matricentric o mother is given a dominant position because of the father's prolonged absence. ON THE BASIS OF RESIDENCE: (1) Patrilocal family: o The family in which after marriage wife comes to reside in the family of her husband (2) Matrilocal family: o The family in which after marriage husband comes to reside in the family of her wife (3) Bilocal family: o In this type of family after marriage the married couple change their residence alternatively o this type of family is also known as family of changing residence. (4) Neolocal family: o After marriage when newly married couple establish a new family independent of their parents and settled at a new place this type of family (5) Avunculocal family: o After marriage when the newly married couple reside in maternal uncle’s house the said type of family o Avuncu means maternal uncle. FAMILY RELATIONSHIPS AND INTERACTIONS ORDINAL POSITION FIRST BORN Generally persevering Serious, More responsive to adults, Achievement oriented MIDDLE CHILD YOUNGEST Optimistic Demanding Sociable, aggressive, competitive, occasionally manipulative Outgoing, occasionally narcissistic, by nature are affectionate PARENTING STYLE AND CHILDREN BEHAVIOR 1. Democratic parenting • Establish clear rules and expectations and discuss them with their children. Although they acknowledge the child’s perspective, they use both reason and power to enforce their standards o Energetic friendly, self-reliant, and cheerful, achievementoriented child 2. Authoritarian parenting • More rigid rules and expectations are strictly enforced to the children. It demands extreme obedience and loyalty from their children o Unfriendly, Conflicting, irritable. Unhappy and unstable child 3. Permissive Parenting • Parents let the child preferences take priority over their ideals and rarely force the child to conform to their standards. Children are in control of the family and not their children o Impulsive and rebellious, Low achieving child 4. Rejecting Parenting • Parents do not pay attention to their children needs and seldom have expectations regarding how the child should behave o Immature, Psychologically troubled child 5. Uninvolved Parenting • Parents often ignore the child, letting the child’s preference prevail as long as those preferences do not interfere with the parent’s activity. o Lonely and Withdrawn, Low Achieving child SUMMARY OF PARENTING STYLES AND CHILDREN’S BEHAVIOR PARENTING CHILDREN’S BEHAVIOR STYLE Energetic-friendly, self-reliant and Democratic cheerful, achievement-oriented Unfriendly, conflicted and irritable, Authoritarian unhappy and unstable Permissive Impulsive and rebellious, low-achieving Rejecting Immature, psychologically-troubled Uninvolved Lonely ad withdrawn, low-achieving THE “FAMILY LIFE CYCLE” • Represents the composite of the individual developmental changes of family members • Presents cyclic development of the evolving family unit • Determined from index patient's point-of-view • Important in understanding health and illness responses of patients and their families WHY DO WE STUDY THE FAMILY LIFE CYCLE? • It provides a predictable, chronologically oriented sequence of events in family life with which family physicians and other health professionals are already familiar with • It involves a sequence of stressful changes that requires compensating or reciprocal readjustments by the family if it is to maintain viability. • Events of Family Life Cycle can be related to clinical events and to health maintenance of the family 2 LEVELS OF ORDERS OF MAGNITUDE OF CHANGE: • First order Changes - “need to DO” o Accomplished by the family within the stage o Involve increments of mastery and adaptation to change o Do not involve or with minimal change in the main structure of the family o Do not involve change in an individual’s identity and self-image • Second Order changes - “need to BE” o Accomplished by the family to proceed to the next stage o Involve transformation of an individual’s status and meaning o Change in the very basic attributes of the family system o Change in the role and identity of family members FAMILY LIFE CYCLE STAGE UNATTACHED YOUNG ADULT young adult separates from the family of origin but without abandoning emotional refuge to that family NEWLY MARRIED COUPLE transition from family to life as a married couple à Commitment See Table below for stages in a newly married couple (SIX-STAGE CYCLE by Lauer & Lauer, 2004; Goldenberg & Goldenberg, 2002) HEALTH ISSUES OF FIRST ORDER CHANGE SECOND ORDER CHANGE CONCERN REWARDS • Employment • Accommodation • Extend social circle • Financial independence • Differentiate self from family of origin • Develop intimate peer relationships • Proper nutrition • Physical fitness • Safe sex practices • Romance, Freedom Establish: • Home base • Mutually satisfying financial, sexual, intellectual, and emotional relationship • Plan for possible offsprings • Form a stable marital system • Realign relationships to include spouse • Pregnancy and childbirth • Couple time, Intimacy / Belongingness TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 68 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. STAGE FIRST ORDER CHANGE FAMILY WITH YOUNG CHILDREN starts with pregnancy for the first child to the emergence of adolescents. FAMILY WITH ADOLESCENTS the stage starts when the first child reaches adolescent age (age 12) LAUNCHING FAMILY begins when the first child leaves home, ends with an empty nest FAMILIES IN LATER YEARS begins with the departure of the last child and continuous through retirement of one or both of the couple and ends when both are dead; acceptance of shifting generational goals SECOND ORDER CHANGE • Supply adequate space, facilities and equipment for the expanding family • Tapping enough resources • Taking on parental roles • Maintaining mutually satisfying sexual relationships • Encourage children to develop peer relationships • Share child-rearing, financial, and household tasks • Realign marriage and relationships to include children • Realign from family of orgin to include parenting and grandparenting • Sharing of tasks and responsibilities • Provision of needs • Working out financial and marital issues • Increase flexibility to boundaries to include children's independence • Refocus on midlife, marital and career issues • Beginning the shift towards concern for the older generation • Gender identity and sexual orientation • Drug dependency and smoking • Adjust in physiologic changes of middle age • Participating in community activities • Realignment of marital system as a dyad • Development of adult relationships with children • Realign relationships to include in-laws and grandchildren • Dealing with death • Non-communicable diseases (hypertension, heart disease, arthritis, osteoporosis) • Menopause • Weight problems • Adjust in physiologic changes (or decline) of later life • Participating in group activities • Maintaining contact with younger generations • Exploration of new familial social options • Dealing with loss or death • Support for more central role of middle generation STAGES IN A NEWLY MARRIED COUPLE STAGES Honeymoon Stage (0-2 years) Early Marriage Stage EMOTIONAL ISSUES Commitment to marriage Maturing of Relationship (2-10 years) Middle Marriage Stage Post-care review (10-25 years) Long Term Marriage Stage Farewells and planning (25+ years) HEALTH ISSUES OF CONCERN • Childhood illnesses • Healthy child development: immunization and preventive health • Chronic physical or psychologic illnesses • Degenerative conditions • Debility REWARDS • Generativity, joy in watching child develop • Enriched identity as a family • Shared responsibility in the home • Mother’s world expands • Joy in watching child develop • Beginning of new kinds of relationships in the family • Increasing independence and competence in the children • Friendship with the children • Entry of caretakers into new arenas (carer, volunteer) • More time for spouse and friends • Freedom: finances and time • Children settling in • • • • Grandchildren Back to “coupleness” Fulfillment in life Decrease in tasks, free time • New relationship with widow/ers friends IMPACT OF ILLNESS IN THE FAMILY STAGE CRITICAL TASKS • Differentiation from family of origin • Making room for spouse with family and friends • Adjusting career demands • Keeping romance in the marriage • Balancing separateness and togetherness • Renewing marriage commitment • Adjusting to mid-life changes • Re-negotiating relationship • Renewing marriage commitment • Maintaining couple function • Closing or adapting family home • Coping with death of spouse • Illness – encompasses the person’s perceptions, emotions, and experiences of the disease, as well as the suffering and the changes the patient and the family have to undergo in the presence of that disease • Filipino families have close family ties hence, assessment of the impact of illness can also help the physician strategize to help both the patient and the family and to lessen the burden of the illness • Physical impact – decreased physical well-being • Social impact – feeling of social isolation both for the patient and caregiver • Financial impact – greatly felt due to increasing healthcare costs; greater among families in the lower socio-economic bracket • Psychoemotional impact – apparent when patient is seen suffering; depression, anxiety, and sleep problems are common FACTORS INFLUENCING HOW FAMILIES COPE WITH ILLNESS Atwood and Weinstein, Family Practice, Family Therapy: A Collaboration of Dialogue FACTORS Intrafamilial factors Family resources Family stage life cycle Degree of family functionality ENABLERS BARRIERS • Adequate financial resources • Good social support system • Strong spirituality • Ability to tap community resources Stages wherein family members are concentrating within the family Functional families that are flexible in adapting to changing roles, have healthy communication lines, and provide good emotional support • Limited financial resources • Lack of social support group • Lack of access to community resources • Acute, self-limiting • Non-fatal diseases without incapacitation • Acute and life threatening • Chronic and debilitating • Rapidly progressive • Terminal illness Highly communicable diseases that carry with it a social stigma isolating patients and families Stages that are supposed to launch members outside the system Dysfunctional families with poo lines of communication and poor emotional connectivity External factors Typology of illness Onset, course, outcome, degree of incapacitation Stigma associated with the disease Diseases that do not carry a social stigma TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 69 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. ASSESSMENT OF FAMILY’S ABILITY TO COPE • Active listening o Guide questions: § What is the nature and characteristic of the illness? § What does the illness mean to the patient and to his/her family? What are their fears and uncertainties regarding the illness? § How have they been coping with their illness so far? What has helped or hindered them? § How did the experience of illness change the patient and the family? STAGES Stage I: Onset of Illness to Diagnosis Stage II: Impact Phase / Reaction to Diagnosis • Family Assessment tools o Genogram – emphasize family’s roles o Family map – familial relationships o Family APGAR – degree of functionality o SCREEM – resources available to the family FAMILY ILLNESS TRAJECTORY • The normal course of the psychological aspects of disease for the patient and the family. • Knowledge of the trajectory allows the physician to predict, anticipate and deal with a family’s response to illness. • Shows normal and pathologic responses thus enabling family physicians to formulate special therapeutic plan. DESCRIPTION • The stage experienced prior to contact with the physician. • Starts from physical symptoms of the patient (or patient feels that there is something wrong) • Health beliefs and previous experiences provide influence to the meaning of illness and how soon they seek consult • • • • Initial contact with MD Aspects of reaction: cognitive, emotional Curable / non-debilitating → leads to acceptance Chronic / debilitating / terminal → protracted reaction (DABDA) Stage III: Major Therapeutic Efforts • Period of great mobilization • Psychological state and preparedness of the patient and the family determine the choice of therapeutic plans as well as the alternative choices. • Assumption of responsibility for care • Economic impact of illness • Lifestyle and cultural characteristics of a family are important in choosing a therapeutic plan. • Hospitalization gives rise to stressful problems usally depending on the family role of the patient Stage IV: Early Adjustment to Outcome – Recovery Phase • Acute, self-limiting illnesses → disappearance of symptoms • Chronic illnesses → return to home with some degree of functionality • Crisis arises when there is partial recovery, permanent disability, or an expectation of death • Return from the hospital or major therapy initiates a period of gradual movement from one role of being sick to some form of recovery or adaptation, with corresponding adjustments of relation within the family. • 3 types of anticipated outcome: 1. Return to full health 2. Partial recovery 3. Permanent disability – requires acceptance Stage V: Adjustment to the permanency of outcome • It points to the family’s adjustment to crisis. • 2nd crisis occurs as family realizes that they must accept and adjust to permanent disability. Kleinman’s Explanatory Model of Illness • Explanatory models of illness o the way people perceive, interpret and respond to it o are mediated not only by the illness itself, but also by cultural and social contexts. o gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. • Targeted questions: o What do you think has caused your problem? o Why do you think it started when it did? o What do you think your sickness does to you? How does it work? o How severe is your sickness? Will it have a short or long course? o What kind of treatment do you think you should receive? o What are the most important results you hope to receive from this treatment? o What are the chief problems your sickness has caused for you? o What do you fear most about your sickness? SUPPLEMENT RESPONSIBILITIES OF A PHYSICIAN • Explore routinely the explanatory model of illness and fear that the patient brings to the clinical set-up. • Most difficult stage for the patient! • Explore what they know and what they would like to know; small doses of medical information • Anticipate number of problems and help families cope and adapt to the situation. • Interpret findings which are misunderstood; avoid use of medical jargon • Consider all factors in formulating your management plan including cost effectiveness and family beliefs • Provide information as needed and desired. • Work in harmony with the patient and the family. Family is the therapeutic ally • Remain open to the family – indicate that they will not be abandoned. • Explore patient’s and relatives’ reaction to therapy and its progress → assess satisfaction level • Most challenging and rewarding stage for the physician! • Deal with immediate effects of trauma brought upon by the illness • Alleviate anxiety and assure adequate rest • Prepare family for all possible outcomes to help create a realistic plan of management • Give psychological support • Explore the level of understanding of patient and family of the experience that they have gone through • Assist the patient and the family in relating to the health care system • Caregiving skills and materials (home care) • Tapping community resources • Aid the patient and the family in efficient and functional readjustment SUPPLEMENT: SPIKES Model for Breaking bad news This framework is used in disclosing medical information particularly regarding to patients with chronic or terminal disease. • Setting (SETTING UP the Interview) – must be done in a private or confidential place, may or may not be accompanied by other medical staff. • Perception (ASSESSING THE PATIENT’S PERCEPTION) – This step is the center of the “before you tell, ask” principle. Before you break bad news to your patients, you should glean a fairly accurate picture of their perception of the medical situation—in particular, how they view the seriousness of the condition. The exact words you decide to use de- pend on your own style • Invitation (OBTAINING THE PATIENT’S INVITATION) – Asking the patient if they would like to know the details of their condition. Although most patients want to know all the details about their medical situation, you can’t always assume that this is the case. Obtaining overt permission respects, the patients’ right to know (or not to know) • Knowledge (GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT) – disclosure of the bad news is made Kleinman A., Eisenberg L., Good B. Culture, illness,and care: clinical lessons from anthropological and cross-cultural research. Ann Intern Med 1978;88:251–88. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 70 of 77