PCM ALL Summary - Dr. Ziad Mahana PDF

Level 1 - Semester 1 PCM SUMMARY DR ZIAD MAHANA   Traits of professionals including…  Empathy.  Advocacy....

Level 1 - Semester 1 PCM SUMMARY DR ZIAD MAHANA   Traits of professionals including…  Empathy.  Advocacy.  Creativity. A set of values , relationships, attitudes , and behaviors (VRAP)  Reliability.  Professional competence.  Innovation. So… Professionals places patients well-beings as priority.  Collaboration.  Altruism.  Leadership.  Cooperation. ' 1. Professionalism ⮅ the sense of responsibility & improves the patient care  Focuses on:  Measures: 2. Professionalism has to do a lot with effective communication skills.  What one can do & should  One’s behavior against 3. Professionalism is the moral understanding among medical practitioners. do. established rules or norms.  Disadvantages The American Board of Internal Medicine (ABIM)  It defines: Placing emphasis on accountability 1. duty & moral obligation. ⇩ COMPOSED OF: 2. Responsibilities to: Risks that too much attention may be Individual patients. focused Health care professionals. on the rules “with both agent & overseer” Society. ⇩ The profession. Losing sight of what is ultimately important. ⎚ A conscientious effort to exceed ordinary expectations.  Principles are built upon the establishment of... ⎚ A commitment to lifelong learning with new knowledge that requires a 1. Clinical Competence commitment to continued learning as… 2. Communication Skills 1. New studies. 3. Ethical & Legal Understanding 2. Practice guidelines. 3. New drugs. 4. The efficacy & safety of existing drugs.  pyramid of Professionalism 5. Advances in technology change. 1. CHARACTER DOMAIN (Personal domain) 6. New legislation & policies. 2. CONNECTION DOMAIN (Interpersonal compatibility) 3. COMPETANCE DOMAIN (Professional capability) 1  ⎚ To respect others is to hold in high regard their feelings, opinions, and values.  A professional person will: 1. Individual patients & their families. 1. Take pride in doing a job well. 2. Other health care professionals, colleagues, coworkers. 2. Take personal responsibility. 3. Others with whom they come in contact. 3. Seek to develop and improve their skills. 4. Not be satisfied with a substandard result. 5. Be prepared to acknowledge mistakes. 6. Show respect for those who consult them.  Means to attend to the needs of others & to have personal concern for the well-being of another.  To recognize & understand the needs of others.  But more important to act on this compassion & desire to help them.  Many of the characteristics listed: Relate to those directly linked to a person’s professional role & are generally concerned with the individual’s ability to carry out their duties. But in medicine, this is not enough; the caring nature of the profession means that a ⎚ Seek and accept feedback & constructive instruction healthcare professional must possess a strong sense of empathy, a desire to do good.  From: Teachers – Peers – Residents – Faculty.  In order to: Continually improve educational experience.  Examples: ⎚ Commit to the highest standards of competence. 1. Compassion for those suffering pain & hardship. ⎚ Be mindful. 2. A proper & responsible role in society. ⎚ Develop productive strategies for correcting mistakes: 3. A responsible attitude to the environment. ⎚ Refrain from using illicit substances as 4. Good employment practices.  Alcohol. 5. An awareness of social issues “Where the medical profession is in a position to play  Drugs. an important or central role” ⎚ Be considerate. 6. Humanity in both professional① & personal matters②. ⎚ Respectful of: Others (Teachers – Peers – Residents – Faculty). 7. Adherence to the law. ⎚ Meet the expectations: for participation & timeliness that are communicated to me by those who teach me. ⎚ Recognize limitations & seek help: when one’s expertise, knowledge, or level of experience is inadequate to handle a situation in the classroom, hospital, or research setting. 2   Interactive services (videoconferencing) can provide immediate Practicing medicine over a distance… in which diagnoses and subsequent treatment. adviceto patients who require medical attention.  Tele neuropsychology is an example of this type. Refers specifically to remote clinical Can refer to remote non-clinical services, such STORE AND FORWARD REMOTE MONITORING services as: (SELF-MONITORING OR SELF-TESTING)  Tele-training.  Surpasses need for  Uses technological devices to  Tele-education. medical practitioner to monitor health &clinical signs  Tele- monitoring. meet inperson with a of a patient remotely.  Tele-support. patient. COMMONLY USED IN  Medical fields of:  Management of chronic diseases:  Radiology.  Cardiovascular disease. ❶ Improved diagnosis and better ❶ Early diagnosis and treatment.  Pathology.  Diabetes mellitus. treatmentstrategies. ❷ Early detection of disease.  Dermatology.  Asthma. ❷ Continued education and training. ❸ Access to expertise of medical specialists ❸ Quick and timely follow up of ❹ Access to specialized health care services  Telemedicine facility - Apps - Video on chat platforms. dischargedpatients. tounder- served rural and remote areas.  Phone. ❹ Access to computerized ❺ Reduced travel expenses. TELEMEDICINE  Specialized telemedicine smartphone Apps, comprehensive data of patients, both ❻ Reduced visits to specialty hospital. CHAT-BASED APPLICATIONS Websites, other internet-based systems. offline and Realtime. ❼ Reduced burden of morbidity. ASYNCHRONOUS  Email/ Fax etc. 3   FIRST CONSULT for  Telemedicine consultation ❶ High risk patient with complex presentations. diagnosis/treatment/healtheducation/ should belimited to: ❷ Do not have access to the patient`s medical records. counselling.  First aid. ❸ You need to examine the patient.  Life-saving measure. ❹ Unsure about the mental capacity of the patient  FOLLOW-UP CONSULT.  Counselling and advice on referral. ❺ You are prescribing high risk drugs. 1. Patient to physician. 2. Caregiver to physician. 3. Physician to physician. 4. Health worker to physician. ❶ Patient`s fear and unfamiliarity. ❹ Government support. ❷ Financial unavailability. ❺ Perspective of medical practitioners. ❸ Literacy rate and diversity in ❻ Lack of basic amenities. languages. ⎚ Telemedicine should be employed primarily in situations in which a physician cannot bephysically present within a safe and acceptable time period. ⎚ The patient-physician relationship must be based on mutual trust and respect… ❶ Identification of Physician and ❹ Patient Evaluation.  It is therefore essential that the physician and patient be able to identify Patient. ❺ Patient Management. eachother reliably when telemedicine is employed. ❷ Mode of Communication. ❸ Consent. ⎚ An informed consent must be obtained from the patient. ⎚ The physician must aim to ensure that patient confidentiality, privacy, and dataintegrity arenot compromised.  Loosening accountability  Compromising confidentiality ⎚ The physician must ensure that the patient has understood the advice and treatment.  Blurred professional boundaries ⎚ A physician should not violate the local rules and regulations.  Depiction of unprofessional behavior  Legal issues 4  REFLECTION → A metacognitive** process: “A WIDELY USED MODEL” That occurs before - during - & after situations. With the purpose of developing greater understanding of both the self & the situation. You provide a detailed description of the experience you are  Reflection in the education context : a process in which thoughts are reflecting upon. ‘turned back’ so that they can be interpreted or analyzed. Reflect on your thoughts & emotions during the experience.  ⮅ Self-awareness.  Improve decision making skills ① You critically analyze the experience.  Encourage Empathy. ② Evaluate its positive & negative aspects.  Improve communication. ① Reflect on the situation.  Improve critical thinking. ② Try to make sense of it.  Enhance lifelong learning. ① Draw conclusions from your analysis. ② Identify key lessons learned from the experience. ① Determine what actions you will take ② Set goals for personal development & improvement. ③ Make a plan for implementing these changes in your future practice. 5  1. Continuous Learning & Improvement Writing a reflective journal or diary 2. Adaptability 3. Patient care & safety Engaging in reflective discussions with peers or 4. Well-being colleagues Regular feedback from mentors & supervisors Using a portfolio or collection of evidence “That reflect on one's learning & professional  This is the phase where learners: development” Set goals. Make a plan. Gather the resources they need. Determine their motivation.  Time limitations  This is the phase where learners:  Emotional discomfort Take action & Do the task towards their goal.  Fear of judgement Use their plan & Put in effort to complete the task.  Lack of role models Monitor their progress. Make adjustments to their strategies  This is the phase where learners: Reflect on their performance. ① Monitor ① Thoughts Evaluate their progress towards their goals. The ability of individuals ② Control their ② Emotions to achieve desired goals Assess their strengths & weaknesses. to ③ Adapt ③ Behaviors Identify areas for improvement. Consider strategies to enhance their future learning. 6  1. Time constraints 2. Lack of exposure & awareness 3. Limited resources 4. Resistance to change  The state by which an institution has an implicit awareness of  Implies an explicit identification & society’s priority health needs & prioritization of health needs. challenges.  Curriculum integration  Community engagement  Community partnerships  Research & evaluation  Flexible scheduling  Self-reflection & continuous learning  The obligation of medical schools to direct their education①, research② & service activities③ → towards addressing the priority health needs of the community①, region②, and/or nation they have a mandate to serve③. 7  Maintain  Learn to prioritize self-care and set limits on study boundaries hours - work commitments - social obligations. ➊ Self-care practice Prioritize self-care activities that promote physical - mental🅔 - emotional🅔 well-being. Time management Develop effective time management skills to balance academic requirements and personal life. ➊ Reach out for support. 🅔 Build a strong support system of friends - family - peers - mentors… Seek support 🅔 Utilize available resources such as: ① Counseling services. ② Mental health support. ③ Student support groups. Set realistic expectations  Incorporate mind fulness and stress reduction techniques into daily routines… Practice  This can include: mindfulness and ① Deep breathing exercises. stress reduction technique ② Journaling. ③ Engaging in activities that promote relaxation & stress relief. Practice self reflection Maintain work life balance 8   It is the principles and rules that give standards of good  System of moral principles that apply values & & bad, right & wrong.. judgments to THE PRACTISE OF MEDICINE.  Unenforceable norms & values guide behavior  Values are written into enforceable standards of behavior  There are no specific laws  Laws are enforced by the justice system 1. Respect self-determination or autonomy:  The patient’s right to decide & act for oneself (The  The practice of a person or institution of authority patient can accept or refuse the examination or the making decisions for a person without his treatment) knowledge/consent with the belief that it is in their best interest 2. Mental capacity:  Essential to understand & weigh up the options to make a choice 3. Honesty. 9 4. Confidentiality: To keep the patient’s information secret & to tell such information to a third party. All patients have the right of confidentiality BUT… Confidentiality is not absolute, especially if other people are at serious risk of harm. 5. Fairness & Equity:  Treated fairly  People with equal needs → should be given equal consideration  Not be discriminated against in the provision of health services.  Fairness & equity (distributive justice).  justice & equality:  The sufficiency view (everyone has essential care - what is essential can vary).  Judgments may be affected by many factors. 6. Compassion:  Understanding & concern for another person’s problems. 7. Competence:  How to ensure competence → Physicians undergo a long training period.  Knowledge, clinical reasoning & technical skills. 10  The 4 pillars of principlism A physician should act in the best interest of the patient (Doing good & promotes well-being) Not to do harm. Treat equitably & distribute benefits fairly. A doctor is free to accept or refuse to treat a patient, except emergencies. He may refuse to treat the patient in following circumstances: ① Beyond his practicing hours. ② Not belonging to his specialty. ③ Illness beyond the competence & qualification of the doctor ④ Doctor or any other family member is ill. ⑤ Doctor having important social function in family. ⑥ Doctor having alcohol. ⑦ Patient is malingering. ⑧ Patient has been defaulting in payment. ⑨ Patient or his relatives are abusive/uncooperative. ⑩ Patient refuses to give consent. ⑪ An unaccompanied minor or female patient. ⑫ When doctor remains engaged with an emergency or more serious case. A THIRD PARTY has referred the patient for medical examination: ① Pre-employment. ② Insurance policy. ③ Yearly medical checkups. ④ Cases of rape or victims of crimes or Medico-legal cases. ⑤ In certain psychiatric illnesses referred by court/ police. 11  Before practicing medicine, physician should obtain : 8. Consent 1) Permission to practice the profession  A mentally sound Adult. 2) The registration number from SMC (State Medical Council) represented in  Aged: > 18 years in Egypt  Patient must be told of all the relevant facts:  In non-medical terms.  NOTIFICATION OF Births and deaths  In a language the patient understands.  REPORTING OF Cases of poisoning Suspected causes of death Sufficient for Needed for Cases covered under the privileged communication Medical examination. Interventions.  RESPONDING TO Call for emergency & military services Non-invasive investigations. Operations. 1) TREAT 2) OBTAIN 3) ISSUE 9. Investigations 4) CONDUCT 10. Emergency cases 5) ATTEND 11. Operations 6) INSPECT PRISONS 12. Professional secrecy/confidentiality - Maintaining the medical records:  The physician should maintain the medical records of his indoor  WHEN? patient period of 3 years from the date of commencement of the It begins the moment the physician-patient relationship is established… treatment.  Starts when the physician agrees to treat the patient  WHEN? → Done On request.  BY WHOM? → Either by the patients or legal authorities Physician has to comply with the directive of the party demanding such examination. The same should be issued within a period of 72 hours 13. Prognosis  Duties of a physician towards patients 1. Exercise reasonable degree of skills and knowledge (competent) He owes this duty even when the patient is treated free of charge. He should not guarantee cure or an assured improvement. 2. Attendance and examination 3. Prescribe proper, suitable, and approved medicines. 4. Control and warn 5. Instructions 6. Sufficient information 7. Third parties 12  Attending physician vs consultant  Workplace environment rights:  Consultation is advised with a specialist in the following conditions:  The physicians have right to refuse: 1. In case of emergency. 1. To perform certain procedures or treatments that violate their moral, religious, or 2. If the patient requests consultation. ethical beliefs. 3. In cases where diagnosis remains obscure. 2. To accept patients unless it is an emergency or a humanitarian situation. 4. In connection with organ transplantation. 5. When treatment or operation involves risk of life. 6. When an operation involves mutilation or destruction of an unborn child.  Responsibility of physician towards colleagues 1. No insincerity, rivalry, or envy. 2. All due respect should be observed towards the physician in-charge of the case 3. Consultant not to take charge: As consultant should normally not take charge of the case. 4. Appointment of substitute. 13  Summary on Lecture (7): “Informed Consent” : ‫يف اتنني الكم‬ ‫احملارضة دي بتتلكم عن "املوافقة" اليل بناخدها من العيان قبل أي حاجة و قبل معلية او قبل حفص معني‬ ‫ اميت بناخدها واميت ال‬ ‫ أنواع املوافقة‬ ‫ اميت بتبقي ابيظة‬ ‫ وشوية مواقف وحلها‬  Conditions in which the person lacks mental capacity 1. Mind is impaired & unable to give a decision. 2. Severe learning disabilities. A voluntary agreement, compliance or permission. 3. Brain damage: From a stroke or other brain injury. 4. Physical or mental conditions that cause confusion, drowsiness or a loss of consciousness. Incapacious 5. Intoxication caused by drugs or alcohol misuse. person IN CASE OF LACK OF CAPACITY !! ⎚ Another one can give or refuse consent → for example  An adult partner  Legal custodian  And/or an adult family member who is responsible for patient Assessment of mental capacity ? The ability to…  An expert advice from a psychiatrist or psychologist with  Use & understand information to make a decision. By whom particular experience in assessing capacity.  Communicate any decision made.  A person with normal healthy mind & brain function. Capacious or Competent  Who can generally understands what decision he/she needs to make & its consequences 1  Implied consent  It is specifically stated by the patient in distinct & explicit language.  It is the ability to think, decide & act for one self.  It can be: GENERALLY  Adults with mental capacity who understand the options could ORAL/VERBAL CONSENT WRITTEN CONSENT accept or refuse them. (Preferably in presence of disinterested party, like a nurse)  Is the patient’s right to decide whether to agree (consent) or OBTAINED FOR to refuses (refusal) of certain clinical examination or IN MEDICINE  Relatively minor examinations or  All major diagnostic procedures. treatment. therapeutic procedures as… ① Endoscopy.  “YES” to examination or treatment “i.e. consent” or to say “NO” ① Blood collection for lab tests. ② Bone marrow aspiration, etc. “i.e. refusal”. ② ECG.  General anesthesia. To examine, treat or operate upon a patient without consent is assault in law  Operations. Consenting Ages for treatment (in egypt)  The age of consent for medical examination, treatment, any diagnostic or invasive procedures is legally accepted as ≥ 18 years (age of full civil rights in Implied consent Egyptian law).  When the patient presents himself at the doctor's clinic or outpatient  For a child, or a patient of unsound mind…  This implies that he agrees to be examined (Inspection – Palpation – Percussion –  His/her guardian or a local authority designated to care for the child can give consent. Auscultation). Expressed permission as ① Further examinations () like Rectal or Vaginal ① Condition or nature of illness. ② Withdrawal of blood for diagnostic purposes ② Purpose & nature of procedure or treatment proposed. ③ Risks & benefits of treatment or procedure. ④ Prospect of success or failure. ⑤ Risks & benefits of alternative treatment(s) or procedure(s). ⑥ Prognosis in the absence of intervention. ⑦ Acceptance or refusal (informed refusal) of the given procedure or intervention. 2   Cannot be examined without consent. THE VICTIM  The court cannot force a person to be medically examined.  Can be examined by a doctor using reasonable force In criminal ❷  If requested by a police officer cases AN ACCUSED  & If the examination may provide evidence to the commission of the offence. AN ARRESTED  At his request → May be examined by a doctor PERSON  To detect evidence in his favor.  Served by whom? A FEMALE MEDICAL PRACTITIONER A MALE DOCTOR 1. Consent should be: Free – Voluntary – Clear – Intelligent – Informed – Direct – Better made by or under Such an examination must be carried Personal. the out in the presence of a female nurse 2. There should be no: Fraud – Misrepresentation of facts – Compulsion – Coercion. supervision of her Female 3. The knowledge regarding the intervention: Should be imparted in an ❸ examination understandable language & format → So that a decision can be made by the  Situations patient. IN MEDICO-LEGAL CASES 4. It should be in a proper form & suitably drafted for the circumstances. IN RAPE (OF PREGNANCY, DELIVERY, AND ABORTION) 5. The written consent should be witnessed by another person, present at the signing. The victim should not be The woman should not be examined examined without her written consent Without her consent  Where there is no nearest relative or where the physician or ❹ For sterilization & artificial insemination  Consent of husband & wife. institution has been unable to find the nearest relative, a physician may For mass immunization ❺  Law provides the consent. provide necessary treatment if: Or any procedure made compulsory by No nearest state ❶ relative 1. He believes that the proposed treatment is essential. ❻ For donation of organ after death  The will of the deceased is enough. 2. Another treatment provider agrees in writing that the proposed treatment is essential. ❼ For prenatal diagnostic procedures  Informed written consent of pregnant. ❽ Pathological  Consent of relatives. For autopsy ❾ Medico-legal  No consent from the relatives. 3  Consent is invalid if: 1. It is not an informed consent. 2. Given for committing a crime or an illegal act: Such as criminal abortion. 3. Obtained by misrepresentation or fraud. 4. Given by one who had no legal capacity to give it: A minor or an insane person or under the influence of drugs or intoxication. Exceptions to informed consent 1. Emergencies (e.g. danger to life or limb). 2. Medico-legal postmortem examination. 3. Examination of an arrested accused. 4. Treatment of patient with ‘notifiable diseases’ for greater community interest. 5. Psychiatric examination or treatment by court order. 6. Prisoners (New entrants). Therapeutic privilege DEFINITION  The doctor to withhold from patient the information (as to risk).  If the disclosure would pose serious psychological threat to the patient (e.g. INDICATION malignancy).  Doctor should disclose full information to a competent relative of the SO? patient. Blanket (open) consent  The consent practiced in MOST HOSPITALS  That cover almost everything a doctor might do to a patient without mentioning anything specific. 4  Summary on Lecture (8): “Confidentiality” : ‫يف اتنني الكم‬ CONFIDENTIALITY ‫احملارضة دي بتتلكم عن الرسية يف التعامل مع املريض‬  All identifiable patient information is subject to the duty of confidentiality. ‫ ازاي حنافظ علهيا‬  Information may be: ‫ اميت نفيش ارسار املريض‬ o Written – computerized or ‫ اميت حنافظ علهيا‬ o Recorded (visual or audio) or o Simply held in memory of health professionals. ❶ The individual’s past, present, or future physical or mental health or condition. ❷ Any clinical information about an individual’s diagnosis or treatment. ❸ Pictures, photographs, videos, audiotapes, or other materials of the patient. The duty of the doctor, pharmacist & other medical personnel to keep the ❹ Who the patient’s doctor is and what clinics patients attend and when. secrets they know about the patient away from divulge (i.e. the doctor must not divulge patient secrets), except in certain conditions. ❺ Anything else that may be used to identify patients directly or indirectly. ❻ The past, present, or future payment for the provision of health care to the individual.  Concerned with the setting within which  Concerned with the information the patient’s medical information is taken collected from/about the patient (i.e., the patient’s body). (i.e. The patient’s information).  About right or expectation not to be  About right of an individual to have interfered with and to be left alone. personal, identifiable medical information kept out of reach of others.  Make sure all physical examinations take place in isolation from other patients, unauthorized family members, and/or staff.  It is prohibited to examine the patient in the corridors or waiting areas.  Ensure privacy when taking information from patients.  Provide gender-sensitive waiting and examination rooms. 5   Always take permission from the patient before starting any Never inappropriately access records. examination. Shut/lock doors, offices, and filing cabinets.  Give patients enough time to expose the part with pain. Query the status of visitors/strangers.  Avoid keeping patients for periods more than required by the procedure. Advise senior personnel if anything suspicious or worrying is noted.  Provide proper clothing for inpatients.  Discuss patient’s medical information with unauthorized family members.  Make sure your patient’s body is exposed ONLY as much as needed by  Disclose patient’s information the examination or investigation.  Collect information not related to provision of care.  Answer any query by third parties, even when enquired by  Make sure patients are well covered when transferred from one place to close relatives, either with regard to the nature of illness or any subsequent effect of such illness on the patient, another in the hospital. without his/her consent.  Patients should have separate lifts and be given priority.  Regulate access to medical information.  Make sure there is another person (nurse) of the same gender as the  Address how any breach to confidentiality is managed. patient present throughout any examination.  Only relevant personnel allowed to enter examination room at any time  Sharing of information with other staff (Unless in cases of during examination (No unrelated non-hospital person should be allowed consultations and second opinion). to be present).  Accessibility to the medical records.  Main measures you (with your institution) need to follow when dealing with patients’ information:  Clinical details should be separated from demographic data.  All data transmitted by email should be encrypted.  log out of any computer system or application when work is finished.  Do not leave a terminal unattended and logged in.  Do not share Smartcards or passwords with others.  Change passwords at regular intervals to prevent others using them.  Clear screen of a previous patient’s information before seeing another.  Hold in secure storage. THE DOCTOR IS OBLIGED TO MAINTAIN THE SECRETS THAT HE COMES TO KNOW  Tracked if transferred, with a note of their current location within filing CONCERNING THE PATIENT IN THE COURSE OF A PROFESSIONAL RELATIONSHIP system. EXCEPT:  Return to the filing system as soon as possible after use. ⎚ If the patient asks or permits (consented) for this disclosure.  Stored closed when not in use so that the contents not seen by others. ⎚ Relatives & parents are not allowed to know his own secrets  Kept on site unless removal is essential. even after death. 6 ⎚ If the patient is mentally diseased: His relatives should be notified for proper care & treatment. ⎚ A doctor can disclose & discuss medical facts of a case with other doctors & paramedical staff ( nurses, radiologist & physiotherapist) to provide better service to the patient. ⎚ In cases of infectious diseases e.g. typhoid and AIDS: To prevent propagation of the disease everywhere. IF THE PATIENT REFUSES ADVICE OR TREATMENT: He/she should be told that the proper authorities will be notified. ⎚ In cases of diseases that is contraindicated to his job: ⎚ If he is accused by malpractice: He is allowed to divulge secrets about diagnosis & treatment followed. ⎚ When he is required by the law to divulge the secrets. ⎚ When a medicolegal expert is asked to give a certain report in a certain problem. ⎚ Medical persons working for insurance company can refuse to give a report about one of his own patients. 7  Summary on Lecture (9): “Successful communication”  In some instances, the receiver might have feedback or a : ‫يف اتنني الكم‬ response for the sender. ‫احملارضة دي ملهاش أي الزمة بتتلكم عن ازاي بنتلكم مع بعض‬  This starts an interaction. ‫وازاي نتواصل مع بعض وازاي نتواصل مع املريض‬.... ‫ابعهتاهل‬ Communication is a series of learned skills which is based on 3 pillars: ① Accuracy. ② Efficiency. ③ Supportiveness. All combine to contribute to effectiveness of communication ❶ A process by which information is exchanged between individuals through a common system of symbols, signs, or information. ❷ The process by which we relate & interact with other people. People understand what we are trying to convey. ❸ A mutual process between 2 sides (Dialogue) not a one sided monologue. Always remember the acronym KISS “Keep It Short & Simple” ✘ Without using written or spoken words. ✔ but using voluntary or involuntary non-verbal signals. ① Listening and understanding with passion & respect. ② Expressing views & ideas + Passing information to others in a clear manner.  About 70 % of all our communication efforts are:  Misunderstood  Disliked  Misinterpreted  Distorted  This is the person that is delivering a message to a recipient.  Rejected  Or Not heard  This refers to the information the sender is relaying to receiver.  Even when using the same language & within the same culture.  The transmission or method of delivering message. Doctors cannot practice medicine without effective communication skills &  The interpretation of message. need to learn essentials of good communication more than other professionals… Decoding is performed by receiver  Because patients are humans with sensitive needs. Poor communication causes a lot of medicolegal & ethical problems.  The person receiving the message. 8  The medical interview is the most common communication usually encounter 1. Focus on what is being said. between doctor and patient. 2. Repeat back.  IT CAN BE CLASSIFIED ACCORDING TO THE PURPOSE OF THE INTERVIEW INTO 4 TYPES: 3. Face the speaker and make eye contact.  History taking. 4. Nod your head.  Breaking bad news. 5. Talk after the speaker finish  Consultations. 6. Identify key words that might sum up how the person’s feeling  Obtaining informed consent. (frightened - scared - lonely - a bit down - discomfort).  BUT OTHERS TYPE OF COMMUNICATIONS IS NECESSARY LIKE WITH:  Nurses & auxiliary staff.  Reporting research CLOSED QUESTIONS OPEN QUESTIONS findings.  Colleagues.  Encourage patient to speak in more  Talking to the media.  Administrators.  YES’ or ‘NO’ answer. or depth about something.  Public and legislature.  Evidence in court.  Confirmation of something.  They are open because they invite the person to open up.  Personal attitudes EXAMPLE  Language.  Would you like an extra pillow?  How do you feel?  Time management.  Can you tell me your address?  Is there anything else you would like to tell  Working environment. me?  Ignorance.  Human failings (tiredness, stress).  Inconsistency in providing information. 9  Summary on Lecture (10): “Teamwork” ❶ Forming ❷ Stroming  Group of people who have a commitment to produce a result. ❸Norming ❹Performing TEAM GROUP ❺ Adjourning  A team is interdependent for overall  A GROUP QUALIFIES AS A TEAM ONLY IF performance. its members focus on helping one another ❶ Attendance and punctuality. to accomplish organizational objectives. NOT ALL GROUPS IN THE ORGANIZATION ARE TEAMS ❷ Team spirit. ‫احلبه دول بيحكو يف أمهية الفريق وروح الفريق‬ BUT ALL TEAMS ARE GROUPS. ❸ Consensus decision making. ‫وشوية هبل كده‬ ❹ Active participation..... ‫ ابعهتاهل‬.. ‫قراءة بدون تركزي‬ ❶ Poor organization. ❺ Commitment to assignments. ❷ Insufficient communication. ❸ Misunderstandings. ❻ Civilized disagreement. ❹ Inadequate procedures for problem-solving. ❼ Commitment to ground rules. ❽ Respect everyone’s contribution. ❶ Work effortlessly. ❷ Trust. ❾ Everyone’s opinion is of value, no right or wrong answers. ❸ Good communicators. ❿ Give everyone a chance to speak. ❹ Supportive. ❺ Participation. ⓫ One conversation at a time and no talking over each other. ❻ Innovation. ❼ Motivated. ⓬ Be open and honest. ⓭ Do not discuss what someone has said with others outside the room. ❶ Quick solution. ⓭ Everyone should feel free to ask questions of each other. ❷ Improved productivity. ❸ Distribution of workload. ❹ Diversity of idea. ❺ Better decision. ❻ Motivation. ❼ Learning. 10 11  Summary on Lecture (11): “Physician-Patient communication” : ‫يف اتنني الكم‬ ❶ SETTING THE STAGE ⎚ Appropriate greeting - language. ‫حمارضة رائعة بتتلكم عن ازاي بنتلكم مع املريض وازاي انخد منه‬ ELICITING ❷ ⎚ Open-ended, active listening, summarizing to convey an.. ‫الكم ونراضيه والزبون داميا ع حق‬ INFORMATION understanding.... ‫ابعهتاهل‬ SHARING Assess what is known - what needs to be conveyed - prioritize. ❸ Allow questions. INFORMATION Ask the patient to summarize understanding. ⎚ Shared decision making (Help the patient take the decision - But ❹ DECISION MAKING do not make it for him or her). ❺ SUPPORT ⎚ Empathy and respect - be available. ❶ INCREASES: ① Patient satisfaction. ② Understanding of illness and management.  Gauging correct amount - type of information to give to each ③ Patients’ compliance with treatment. individual patient.  Providing explanations that patient can remember & understand ❷ Reduces the risk of complaint and litigation.  Using an interactive approach to ensure a shared understanding of ❸ Higher levels of job satisfaction. the problem with the patient.  Follows helical model  Involving the patient & collaborative planning increase patient’s ❶ Better assessment of the patient’s clinical and emotional state. commitment & adherence to plans made. ❷ Greater satisfaction.  Enabling the patient to become part of a collaborative process. ❸ Agreement with the proposed plan.  Identifying as far as possible all problems or issues patient has come ❹ Greater treatment adherence, and recovery. to discuss. ❺ Improvements in pain tolerance.  Shows empathy and learn how to handle emotional outbreaks. ❻ Better mental health.  Establishing an agreed agenda or plan for the consultation. ❼ Shorter hospital stays, and fewer referrals.  Making efficient use of time in the consultation. 12   Closing the interview.  Confirming the established plan of care.  This skill is rarely taught in medical schools - clinicians are generally poor at it - medical  Clarifying next steps for both doctor and patient. education typically offers little formal preparation for this task.  Maximizing patient adherence and health outcomes.  Breaking bad news is one of a physician’s most difficult duties.  Many health care professionals tend to define 'bad news' as worst-case scenarios (eg. telling a patient, they have cancer or that their loved one has died).  Inappropriate facial expression or hand gesture. ❶ NON VERBAL  Lack of eye contact. ❷ LISTENING  Interrupting too soon.  Too little - too technical. ❸ INFORMATION  Use defensive words. ❹ VOICE  Inappropriate volume - speed - pitch. ❺ ATTITUDE  Lack of empathy & respect. ❶ Asking closed-ended questions. ❷ Not dedicating adequate time for consultation and behaving as if they are busy. ❸ Looking away and not establishing eye contact. ❹ Giving explanations and solutions early even before patient completes the story. ❺ Frequently checking the time. ❻ Responding or taking phone calls or texting. ❼ Demonstrating a lack of interest. ❽ Asking the patient to tell a short story. ❾ Taking notes or using a computer in a manner that the patient will be ignored. ❿ Engaging in other activities during the consultation. 13  Summary on Lecture (12): “Conflict management” ❸ Conflict resolution skill 3: Improve your nonverbal communication skills ❹ Conflict resolution skill 4: Use humor and play to deal with challenges  DISAGREEMENT: Through which the parties involved perceive a threat to their needs, interests or concerns.  Managing & resolving conflict requires: ① Emotional maturity ② Self-control ③ Empathy  It can be tricky, frustrating, & even frightening. POSSIBLE BY STICKING TO THE FOLLOWING CONFLICT  You can ensure that the process is as positive as ❶ True disagreement. RESOLUTION GUIDELINES: ❷ Perceived disagreement 1. Make the relationship your 6. Learning how to listen. priority. 7. Have patience. 2. Focus on the present. 8. Be impartial. The perceived threat The true threat facing them 3. Pick your battles. 9. Be open to discussion (Open If we can work to: 4. Be willing to forgive. communication). While perception doesn't become ①Understand the true threat (issues) 5. Know when to let something go. 10. Reference to the institutional values. reality ②Develop strategies (solutions) ▼ that manage it (agreement). IMPACT People's behaviors, feelings and ongoing ▼ responses become modified by that Skill 1 Quick Stress Relief We are acting constructively to manage evolving sense of the threat they the conflict. Skill 2 Emotional Awareness confront. Skill 3 Nonverbal Communication Skill 4 Playful Communication ❶ Manage stress while remaining alert & calm. Skill 5 Conflict Resolution ❷ Control your emotions & behavior. ❸ Pay attention to the feelings being expressed as well as the spoken words of others. ❹ Be aware of & respectful of differences. ❶ Conflict resolution skill 1: Quickly relieve stress ❷ Conflict resolution skill 2: Recognize and manage your emotions. 14 15 16  Summary on Lecture (13): “Communication Cultural Diversity” ⎚ Effective communication can help reduce disparities in healthcare outcomes and promoting health equity for all patients.  Having a mix of different cultures, languages, traditions, and beliefs in a community or society. ⎚ Culturally diverse patients may have unique expectations and preferences when it comes to healthcare. ⎚ Effective communication builds trust, empathy, and  Exchange of information, ideas, and feelings between individuals from different understanding between healthcare providers and patients. cultural backgrounds.  It involves understanding & adapting to different communication styles - norms - values ⎚ Effective communication is crucial for successful teamwork in to ensure effective & respectful interactions. culturally diverse environments.  Ability to understand, appreciate, and effectively interact with people from different cultural backgrounds.  Language barriers  It involves being aware of and respectful towards cultural differences and adjusting  Stereotypes & biases one's behavior and communication style to ensure effective and respectful  Different perceptions of time interactions.  Errors in technology & communication tools  Lack of cultural awareness & knowledge  Emotional & psychological barriers  Non-verbal communication cues  Eye contact  Hand gestures ⎚ Effective communication promotes understanding and  Facial expressions respect among individuals from different cultural backgrounds.  Touch ⎚ Effective communication ensures that healthcare  Silence providers understand patients' symptoms, medical  Posture & body language history, and concerns accurately which ensures patient safety. 17  1. Self-reflection & awareness. 1. Providing professional interpreters 2.Develop cultural sensitivity:  Who are proficient in both the patient's language & medical terminology.  Continuously educate yourself about different cultures by… ① Reading books ② Watching 2. Utilizing language assistance services: ③ Documentaries Ⓓ Attending cultural sensitivity training.  Technology-based language assistance services, such as video interpreters, can be used. 3.Engage in cultural immersion Seek:  Opportunities to interact with people from different cultural backgrounds & learn from 3. Using visual aids & written materials: their experiences.  Can enhance patient understanding & engagement. 4. Seek feedback & guidance: 4. Training healthcare professionals  Regularly seek feedback from individuals from diverse backgrounds to understand how  In effective communication strategies & cultural competence can improve patient care. your actions & communication may be perceived. 5. Developing multilingual staff: 5. Collaborate with cultural experts:  Can help bridge communication gaps & enhance patient provider interactions.  Seek guidance & collaborate with cultural experts, such as cultural consultants or community leaders. 6. Practice empathy: Try to understand the experiences of individuals from different cultures. 18  Summary on Lecture (14): “Dealing with Difficult Personalities in the workplace” ❶ ⎚ Recognize that you should not take the behavior of difficult people personally. ⎚ Realize that you are not going to change or fix them, & it is not your job to do so. ❷ ⎚ People don’t change their behavior unless & until they want to. ⎚ Accept that the only person you can change is yourself. ❸ ⎚ Focus on changing your pattern of emotional & behavioral responses to the difficult people SO you make healthy & productive choices that benefit you now & in the long term. ⎚ Manage your emotions when you deal with difficult people. ❹ ⎚ Learn not to take their behavior personally. ⎚ Avoid becoming defensive because this will only make things worse. ⎚ Look deeper (drives & motives). ❺ ⎚ People don’t usually wish to be difficult for the sake of being difficult. ⎚ Examine yourself. ❻ ⎚ Brave & deep self-introspection Examination of your own mental & emotional processes (extra) ⎚ Recognize that dealing with difficult people is a skill worth learning, & it takes practice. ⎚ Assess past incidents & learn from them by asking yourself the following questions: ~ Who was involved? ❼ ~ What happened? ~ How did I feel?  ① Verbal potshots ② Backhanded compliments ~ How did I respond?  ~ How do I wish I had responded?  May be pleasant & cooperative on the surface. ~ What could I do differently in the future to have a positive outcome to a similar incident?  Are never able to: ① Make a decision ② Take a risk ③ Complete an assignment  Problems are always external from their perspective.  Their behavior can be toxic to you, your success & your happiness. 19 ❶ ⎚ Be clear about how you wish to be treated & do not allow them to treat you otherwise. ❷ ⎚ Do not enter into a situation that makes you feel unsafe or threatened. ❸ ⎚ Consider asking a friend - colleague - supervisor to be present during meeting if appropriate.  ◈ They are unable to earn the approval & respect they seek. ◈ They may be noncommittal / feign agreement when asked to perform a task / work with others. However, they will likely be among first to blame others when things don’t work out  ◈ To address their misbehavior directly & bring it out into the open. For example: If the person misses an important deadline, offer to meet with them & inquire why? IF THE CASE IS APPROPRIATE ACTION THEY FEEL UNABLE TO PERFORM ASSIGNED TASK & ⎚ Offer to help them to complete assigned task. UNABLE TO ACKNOWLEDGE THIS OPENLY ◈ An otherwise friendly person who‘s behavior can be disruptive to your DIFFICULT work or the environment. CHALLENGING ◈ Chronic behavior that becomes annoying, distracting, & difficult to ignore. ◈ Potential underlying personality issues. TOXIC ◈ Can be exploitative and threatening. 20 ❶ ⎚ Be calm - Open - Clear - Consistent. ❷ ⎚ Give them your undivided attention. ❸ ⎚ Express empathy. ❹ ⎚ Speak and listen non-defensively. ❺ ⎚ Paraphrase. ❻ ⎚ Begin active problem solving. ❼ ⎚ Mutually agree on the solution. ❽ ⎚ Change Your Approach. ❾ ⎚ Don’t Reward Bad Behavior. ❿ ⎚ Focus on the Goal of the Conversation. ⓫ ⎚ Follow Up After the Initial Discussion. ⓬ ⎚ Recognize Some Things Can’t Be Fixed. 21