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132 Cards in this Set
- Front
- Back
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In California, under what circumstances may a minor give consent without a parent giving consent?
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Contraceptive services, prenatal care except abortions, STI/HIV services (minor must be at least 12), treatment for alcohol and/or drug abuse (minor must be at least 12, may inform parents), outpatient mental health services (minor must be at least 12, may inform parents)
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If a 14 year old comes into the office asking for birth control pills and a pregnancy test, is parental consent required?
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No - though it may show up on the billing statement.
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What is the "H" in HEADSS exam and of what does it comprise?
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HOME: Who lives at home, relations with parents/siblings, feelings of safety, presence of guns
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What is the "E" in HEADSS exam and of what does it comprise?
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EDUCATION: level, grades this year and last, attitude toward school, attendance, special ed needs, career goals, feelings of safety
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What is the "A" in HEADSS exam and of what does it comprise?
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ACTIVITIES: exercise, sleep, sports, job, hobbies, peer relationships, gang involvement, weapon carrying, history of physical fights
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What is the "D" in HEADSS and of what does it comprise?
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Alcohol and other drug use, tobacco use (friends, associates' use)
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What is one of the "S"s in HEADSS and of what does it comprise?
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Sex: Feelings toward same/opposite sex, types of sexual practice, age of first intercourse, gender of partner(s), number of lifetime partners, age of partner, history of STIs, last screens, contraceptive use
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What is one of the "S"s in HEADSS and of what does it comprise?
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Suicide/Depression: Feelings about self, history of depression/mental health problems, suicidal thoughts, suicidal attempts
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What are the components of the HEADSS exam?
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Home, Education, Activities, Drugs, Sex, Suicide/Depression
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What are some of the progressive screening questions for a patient that admits to depression/suicidal thoughts?
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Do you ever feel down?
How do you make yourself feel better? Have you ever thought about hurting yourself? Have you ever made a plan to hurt yourself? Have you ever attempted to hurt or kill yourself? Do you feel like hurting yourself now? |
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What are the Tanner Stages (I-V) for Breasts (female)?
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I - no glandular tissue, areola along chest (prepubertal)
II - breast bud forms, some glandular tissue, areola starts to widen III - breast more elevated and extends beyond border of areola, areola widens along breast IV - breast even more elevated, increased size, areola and papilla form a secondary mound from contour of surrounding breast V - breast reaches final size, areola returns to contour of the surrounding breast, projecting central papilla |
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What are the Tanner Stages (I-V) for Pubic Hair (male and female)?
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I - no pubic hair
II - small amount of long downy hair, slight pigmentation at base of penis and scrotum or labia majora III - hair becomes more coarse and curly, extends laterally IV - adult-like hair quality, across pubis but sparing medial thighs V - hair extends to medial surface of the thighs |
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What are the Tanner Stages (I-V) for Genitalia (males)?
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I - prepubertal (testicular volume less than1.4ml, mall penis of 3cm or less)
II - testicular volume between 1.6 and 6 ml, skin on scrotum thins, reddens and enlarges; penis length unchanged III - testicular volume between 6 and 12 ml, scrotum enlarges further,penis begins to lengthen to about 6 cm IV - testicular volume between 12 and 20 ml, scrotum enlarges further and darkens; penis increases in length to 10 cm and circumference V - testicular volume greater than 20 ml, adult scrotum and penis of 15 cm in length. |
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What are the goals of a sports physical?
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- Prevent sudden death
- Help athletes participate safely - Identify injuries and conditions that may affect participation or overall well-being of the teen |
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What vaccines does the CDC recommend that adolescents receive by age 11-12?
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Tdap (tetanus, diphtheria, pertussis)
Meningococcal vaccine Human papillomavirus (3) Hepatitis B series Polio series Measles-mumps-rubella (MMR) Varicella (chickenpox) (2) Tuberculin skin test (if warrants) |
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What are factors associated with increased risk?
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Lack of close relationships with parents
Minimal parental supervision Family chaos School transitions Peers who participate in risky behaviors Illicit substance use availability Male gender Lack of concern about consequences of behavior |
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What are protective factors for teens?
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Strong verbal and communication skills
Easy temperament Ability to solve problems Sense of humor Empathy Perspective-taking skills Spirituality Strong family functioning and communication Extra-family support from community and/or other adults |
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What is the CHD incidence in women?
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1 in 9 women aged 45-64
1 in 3 women over age 65 Under-recognized and undertreated. CHD kills more women than men yearly. |
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What are the tree steps in preventing CHD?
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Recognize risk factors
Determine level of risk Modify and monitor risk factors |
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What are some reversible risk factors for CHD in women?
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Smoking, hypertension, metabolic syndrome, dyslipidemia: high LDL and/or low HDL
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What are some irreversible risk factors for CHD in women?
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Personal history
Family history (male < 55; female < 65) Menopause Age > 55 CHD equivalent: DM, PVD, AAA, CVD |
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Generally how does one determine the level of risk for CHD?
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Low risk = 0 or 1 risk factor
Intermediate risk = 2 or more risk factors High risk = CHD equivalent |
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Where are the "Hidden" risks for women?
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Positive family plays a larger role in risk for women
High TG (esp >400) - much more risk in women High TC, especially in pre-menopausal women - check their HDL levels Obesity and Sedentary lifestyle *Good news! Modifiable!* |
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What are some additional laboratory tests (besides the typical glucose, cholesterol, etc) to check for women? Some are beneficial for men as well.
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CRP - marker of subtle inflammation
Microalbuminuria - reflection of vascular damage Lp(a) - useful in premenopausal women and postmenopausal women under age 66 |
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What are some specific ways to modify risk? (some specific to women).
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No hormone replacement therapy - except for symptom relief - not to decrease risk of events.
No benefit from ASA unless > 65 COntrol of blood pressure Lipid modification - TG, LDL |
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What are the NCEP LDL goals for women? (apply to men)
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CHD: LDL of < 100
Risk < 20%; LDL of < 130 0-1 risk: LDL < 160 Use of TLC, statins, bile acid sequestrants, nicotinic acid, and/or fibric acids |
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How are parts of the guidelines contraindicated by pregnancy? What can one do?
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Carefully consider risk vs benefit
TG: dietary change, fibrates, fish oil (since eating fish is risky) LDL: statins are contraindicated (Category X); may use fish oil supplementation (Category C) |
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For women with classic or atypical angina, what testing is done?
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Stress testing - exercise stress test is preferred with use of Duke criteria (more specific to women)
Nuclear imaging - Technetium is better than Thallium, to reduce breast artifact - used if patient is unable to exercise |
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Which patients receive angiography? Mention PTCA and CT.
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All high risk patients should undergo an angiography.
PTCA has advantage of treatment upon diagnosis, but requires entering via the femoral artery. CT angiography techniques are improving and is useful as a diagnostic tool - cannot be used as a treatment tool. |
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Typical CHD presentation in women?
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Women tend to develop angina prior to onset of an overt CHD (often ignored...)
During a cardiac event, more likely to experience pain in anterior neck, describe pain as sharp or burning, and rate a higher level Common presentation is overwhelming fatigue |
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What are secondary risk modifications that can be done for women (some apply to men)?
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ASA for all women with known CHD
Beta blockers to reduce cardiac work load ACE-inhibitors Lipid agent to new LDL goal of < 100 Cardiac rehab with bridge to exercise program |
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What are some osteopathic correlates with regard to CHD and the S-ANS?
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S-ANS fibers to the heart originate from T1-T6. They increase heart rate and contractility, cause vasoconstriction, control diameter of thoracic duct and lymphatic channels. Increase cardiac work load, total peripheral resistance
*Right side: right heart, SA *Left side: left heart, VA |
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What are some osteopathic observations following an MI?
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Increased sympathetic tone inhibits development of collaterals
Increased risk of coronary vasospasm Vasoconstriction raises total peripheral resistance and increases cardiac work load |
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What are osteopathic correlates with regard to CHD and P-ANS?
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P-ANS fibers originate in vagus nerve, and increase tone to slow heart rate and conduction, and decreased tone accelerates HR and conduction.
Vagal efferents go to SA node and AV node. |
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What are some common osteopathic presentations for heart problems?
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S-ANS viscerosomatics from T1-T6 will radiate to left arm, shoulder, and jaw as an aching type of pain or to the chest as a squeezing type of pain. "classic pain," viscerosomatic reflex
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What are the side effects of vagal stimulation?
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Cause indigestion, N/V, SOB, wheezing - "atypical pain," viscerovisceral reflex
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What are the TART changes at T1-T6 for a patient with CHD or other viscerosomatic heart problems?
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Positive red reflex, especially on left
Ropiness of musculature (if chronic) Segmental changes Positive Chapman's points Presence of pectoral trigger point |
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How should one approach treating CHD with OMM? Compare with conventional treatment?
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OMM is not a substitute for medical management
Indirect treatment preferred Combine with lifestyle modification |
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What is the treatment approach for patients with CHD and relevant TART changes?
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1. Calm sympathetic hyperactivity of T1-T6 to prevent facilitated segments
2. Open thoracic inlet, then perform pectoral traction for lymphatic drainage 3. Treat any rib, sternum, and hyoid dysfunction as all have fascial continuity with mediastinum 4. Attention to cranial base and C2 for P-ANS |
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What are some of the basic environmental health concerns?
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Drinking Water
Food Land Built Environment Indoor Air Emergencies |
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Why is an exposure so important for a correct diagnosis?
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Many environmental diseases either manifest as common medical problems or have nonspecific symptoms
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What may compromise drinking water/food and produce a health hazard?
What are the potential side effects? |
Inadequate and unsafe water supply and unsanitary excreta disposal
GI disease, parasitic infections, eye and skin diseases |
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What may compromise the land and produce a health hazard?
What are the potential side effects? |
Inadequate waste disposal, chemical dumps
GI and parasitic diseases (vector breeding), chronic disease |
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What may compromise a built environment and produce a health hazard?
What are the potential side effects? |
Toxic materials (mold, asbestos, lead), crowded and structurally inadequate housing
Increased risk of respiratory disease transmission, stress and accidents |
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What may compromise the air and produce a health hazard?
What are the potential side effects? |
Polluted air, feedlot odors
Respiratory distress, infections, lung cancer |
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During an emergency, chemicals and radioactivity are released - what are the potential side effects?
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DIstress, short and long-term health effects (CDC)
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What opportunities may be missed if a clinician fails to ask about environmental exposures?
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Misses the opportunities to...
Influence the course of the disease by stopping exposure Prevent disease in others by avoiding exposure |
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What are some things a physician can do to increase recognition of environmental exposures?
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Be suspicious and think about the possibility of environmental factors of disease
Incorporate an exposure history questionnaire into the practice |
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What are some examples of nonspecific symptoms that may be the only manifestations of an environmental exposure?
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Headache, difficulty concentrating, behavioral problems, rashes, asthma, angina, myalgia, difficulty conceiving, spontaneous abortion
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In a clinical setting, how many physicians included mention of occupation?
How many included information about toxic exposure, duration of present employment, former occupations? |
Only 24% of charts included mention of occupations
Only 2% included information about toxic exposure |
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How often did medical students chart...
smoking status? occupation? occupational exposures? Which patients were less likely to be asked than others? |
Smoking status: 91%
Occupation: 70% Occupational exposures: 8.4% Patients <40 and women were significantly less likely than older patients or men |
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What do clinicians need to do to investigate exposures?
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Have a high index of suspicion and follow through
The same criteria are employed as those used in diagnosing other medical problems (history, palliative and provocative factors, physical examination, lab tests) Consider the long-term or latent effects of past exposures to agents (asbestos, radiation) Extensive knowledge of toxicology is not needed - physicians may consult |
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What points may be elicited by an exposure history?
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Job descriptions associated with hazardous substances, physical, and biological agents
Temporal and activity patterns related to environmental and occupational disease Explore past and present exposures |
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Are exposure and effects acute or chronic? What is the range in latency period?
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Exposure and effects can be both acute and chronic
Latency period may be very short with immediate manifestations of disease, or may be delayed hours or days, or even prolonged (decades) |
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What effects from toxic exposure may be seen in the respiratory system?
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Respiratory system is a target organ and portal of entry, so it's in the front lines.
Asthma morbidity and death from asthma are increasing More than 100 toxicants cause asthma, and many more exacerbate it |
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What effects from toxic exposure may be seen in the skin?
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Irritant and allergic contact dermatitis account for 90% of occupational skin disorders
Other disorders include: pigment alterations, chloracne, urticaria, malignant neoplasms |
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What effects from toxic exposure may be seen in the liver and kidney?
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Symptoms of liver disease mimic viral hepatitis
4,000 new cases of renal disease of unknown etiology annually Organic solvents and heavy metals are known to adversely affect renal function |
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What effects from toxic exposure may be seen in the central nervous system?
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Neurotoxicants can cause peripheral neuropathy - ataxia, parkinsonism, seizures, coma, death
Many chemicals cause mild CNS depression that may be misdiagnosed as intoxication - may progress to psychoses or dementia Sensory impairment - visual disturbances caused by methanol, physical agents (loud noise causing deafness) |
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What effects from toxic exposure may be seen in the female reproductive system?
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Changes in...
Sexual behavior Onset of puberty Cyclicity, Fertility Gestation time Pregnancy outcome Lactation Premature menopause Exposure to lead: menstrual disorders, infertility |
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What effects from toxic exposure may be seen in the male reproductive system?
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Affects sperm count or shape
Alters sexual behavior and/or increases fertility Carbon disulfide is known to disrupt male reproductive health |
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What effects from toxic exposure may be seen in the cardiovascular and hematological systems?
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CV changes
Exacerbation of preexisting CV conditions - exposure to noise, chemicals (MO, tobacco smoke) Benzene may effect bone marrow changes: aplastic anemia, acute leukemia, CML |
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What organ/system is affected most by Radon, asbestos, glues, tobacco?
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Respiratory system
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What organ/system is affected by Dioxin, nickel, arsenic, mercury, cement (chromium) polychlorinated biphenyls (PCB’s), glues, rubber cement?
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Skin
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What organ/system is affected by Carbon tetrachloride, methylene chloride, vinyl chloride?
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Liver
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What organ/system is affected by Cadmium, lead, mercury, chlorinated hydrocarbon solvents?
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Kidneys
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What organ/system is affected by Carbon monoxide, noise, tobacco, physical stress, carbon disulfide, nitrates, methyl chloride?
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Cardiovascular
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What organ/system is affected by Lead, carbon disulfide, methyl mercury, ethylene dibromide?
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Reproductive system
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What organ/system is affected by Arsenic, benzene, nitrates, radiation?
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Hematological system
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What organ/system is affected by Tetrachloroethylene, mercury, arsenic, toluene, lead, methanol, noise, vinyl chloride?
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Neuropsychological
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What are the major sources of indoor pollution?
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Asbestos
Biologic agents Building materials Radon Tobacco smoke Wood stoves/gas ranges Other heating devices |
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Which source of pollution is worse - outdoor or indoor?
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Indoor
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What are the risks in environmental tobacco smoke? Is it preventable?
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It is an entirely preventable public health hazard
it is a mixture of irritating gases and carcinogenic tar particles 43 of the 4,700+ chemicals are known carcinogens |
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What are the risks in wood stoves/gas ranges/other heating devices as a whole? Is there any pattern to exposures?
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These types of combustions are the second major pollutant after tobacco smoke.
Major source: malfunctioning heating devices or inappropriate, inefficient use Incidents tend to be seasonal - fireplaces, gas/water heaters, kerosene space heaters, etc. |
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What are the risks associated with gas ranges in particular?
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Produce Nitrogen Oxide (respiratory irritant)
Used for cooking in >50% of US homes Require proper ventilation Require routine maintenance and inspection |
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What are the risks associated with wood stoves in particular?
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Produce noxious gases including CO, nitrogen oxides, particulates, hydrocarbons
Children have a significant increase in respiratory symptoms vs children without wood stoves |
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What are the risks associated with building materials? Specifically related to what chemical?
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Formaldehyde volatilizes from particle boards, insulation, carpet adhesives, other household products - problematic in mobile homes
Cause rhinitis, eye and upper respiratory irritation, nausea, dry skin or dermatitis, precipitates bronchospasm in Asthma |
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What is asbestos? Where is it found? When was it used? When does it pose a risk?
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Asbestos was mostly used in the 1950s-1970s in areas requiring soundproofing, thermal proofing, durability
When it is intact and undisturbed, generally not a health risk Hazardous if it has been damaged, disturbed in some manner, deteriorates over time and releases asbestos fibers |
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What are the specific health risks associated with asbestos?
What affects the outcome of asbestos exposure? |
Lung cancer, asbestosis, mesothelioma
Effect depends upon... ...type of asbestos mineral inhaled ...concentration and dimension of the fiber ...the duration of the exposure |
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How is cancer risk associated with smoking and asbestos?
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When including asbestos in the equation, there is an increase in cancer risk by an entire order of magnitude.
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Why may children have a higher risk from asbestos than adults?
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Longer life expectancy
Higher activity rates Higher breathing rates Increased amount of time spent on the floor where fibers accumulate Greater likelihood of contact (curiosity, mischief) |
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What is Radon? What are the risks associated with Radon?
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Radon - colorless, odorless gas, a decay product of uranium.
Radon itself does no harm. It attaches to particulate matter which then may be inhaled and decay, emitting high-energy alpha particles which injure bronchial cells and may cause cancer. |
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What percentage of homes in the US exceed the EPA limit of 4 picocuries of Radon per liter of air?
How many cancer deaths does the EPA associate with Radon? |
5-10% of single-family homes exceed the proscribed picocuries of Radon
~14,000 lung cancer deaths/year |
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What are environmental sources of biological agents? What kinds of biological agents?
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Environments: homes, schools, workplaces
Outdoor air Humans shed viruses and bacteria Animal occupants (insects, arthropods, mammals) shed allergans and disease Indoor surfaces and water reservoirs (humidifiers) grow fungi and bacteria. |
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What are the consequences as far as environmental exposures of high relative humidity?
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Encourages house dust mite populations to increase
Allows fungal growth on damp surfaces Mite, bacteria, and fungus contamination can be caused by flooding, continually damp carpet with poor ventilation, inadequate exhaust of bathrooms, kitchen-generated moisture, applications such as humidifiers, dehumidifiers, etc. can harbor stuff. |
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What disease are caused by biological agent exposures?
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Infections
Hypersensitivity disease Toxicosis Nonspecific upper and lower respiratory symptoms Episodes of nonspecific symptoms of "sick building syndrome" |
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When considering the home environments, what are possible sources of exposure?
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Common household products
Lead products and waste Pesticides and lawn care products Recreational hazards Soil contamination Water supply |
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What household products may be possible sources of toxicants in the home?
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Aerosol sprays
Air fresheners, stored Automotive products Cleansers Disinfectants Paints Dry cleaning clothing Fuels Hobby supplies Moth repellents Paint strippers and solvents Wood preservatives |
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Where is Methylene chloride commonly found?
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Adhesive removers, paint strippers, paint thinners
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Where is Paradichlorobenzene commonly found?
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Air fresheners, moth crystals, toilet bowel deodorizers
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Where is tetrachloroethylene commonly found?
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Dry cleaning fluids
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How much higher are some organic chemicals indoors compared to outdoors?
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2-5x higher inside than outside
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After something like paint stripping, how much higher are levels of toxic chemicals inside the house than outside?
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Up to 1000x higher for several hours
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What are the risks associated with pesticides and lawn care products?
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Hazardous, especially to children
Exposure through skin, inhalation, ingestion Include insecticides, herbicides, fungicides, and other antibiological preparations Different MOAs and Toxicities Though extremely hazardous chemicals may be banned in the US, imported foods and other substances may still be contaminated |
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How can one protect oneself against pesticides and other environmental "care" products?
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Proper use and storage of household pesticides
Proper cleaning of food, especially raw fruits and vegetables |
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What risks are posed by lead and other wastes? How is one exposed?
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Lead Products and Waste - bad. Banned after 1972 in paint, but houses still have the old paint, there is exposure via old pipes, significant exposures in soil, acidic foods stored in lead-containing pottery (ceramic glazes)
Children are most at risk |
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What are some recreational hazards?
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Fishing and swimming in contaminated lakes and streams
Wood preservatives in play structures - arsenic-containing, pentachlorophenol, creosote Play sand may have asbestos-like fibers *Arts and crafts materials too!* |
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What is the "Labeling of Hazardous Art Materials Act"?
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It is federal legislation, which requires that all chronically hazardous materials be labeled inappropriate for children's use
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What are the environmental exposure risks associated with water supply?
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Public water supplies and private wells have...
Industrial solvents Heavy metals Pesticides Fertilizers *methylene chloride remains in groundwater for years* *Tricholoroethylene in 10% of wells tested, estimated to be in 34% of the nation's supplies, detectable in 25% of the water supplies* |
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How can toxins get from the water to you?
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Aside from direct esposure via skin, some of the chemicals volatize and may come out in the shower or through cracks in the foundation of a building.
Nitrates are common in rural shallow wells - pose a risk of methemoglobinemia (especially infants) |
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What contaminants may be present in soil? Who is most at risk?
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Children <6 years have the highest risk of exposure
Lead is a common soil contaminant Dioxin also absorbs to soil Certain pesticides (eg chlordane) can remain in soil for years |
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What is the 8th leading cause of death nationwide?
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Medical Errors
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About how many people die from preventable medication errors?
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~7,000
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Define Error
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Error: Failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim
Error of execution, or error of planning |
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Define Adverse Event, as it relates to the practice of medicine.
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An injury caused by medical management rather than the underlying condition of the patient.
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What is a preventable Adverse Event?
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An adverse event attributable to an error
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List four common sources of medical errors.
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1. Wrong synthesis of information
2. Premature closure 3. Inadequate synthesis 4. Omission |
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What kinds of procedures, materials, or information may be involved in medical errors?
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Medicines
Surgery Diagnosis Equipment Lab reports |
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Where do these medical errors occur (locations)?
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Hospitals
Clinics OSU Nursing homes Pharmacies Patient homes |
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What are some examples of an active failure, as a cause of error?
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Slips, lapses, and mistakes
Slip - forgetting to order labs or schedule a consult Lapses - misfiling a lab report in a wrong chart, failing to check on ordered tests to complete workup Mistakes - wrong diagnosis or wrong medication prescribed |
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What are latent conditions?
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Latent conditions - systemic causes, i.e. system interfaces, poor maintenance or management practices.
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What are three common types of errors?
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Diagnostic, Treatment, Preventive
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What is a diagnostic medical error?
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Diagnostic Error: Error or delay in diagnosis, failure to employ indicated tests, use of outmoded tests or therapy, failure to act on results of monitoring or testing.
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What is a treatment medical error?
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Treatment Error: Error in the performance of an operation, procedure, or test; Error in administering the treatment; Error in the dose or method of using a drug; Avoidable delay in treatment or in responding to an abnormal test; Inappropriate (not indicated) care;
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What is a preventive medical error?
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Preventive Error: Failure to provide prophylactic treatment, inadequate monitoring or follow-up treatment
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What were the four most common types of errors in Family Practice?
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24% - Communication problems (nursing, patients)
20% - Discontinuity of care (includes referrals) 19% - Lab results (logistics, timing, followup) 13% - missing values, charting Others... 8% clinical mistake (knowledge and skills) 8% prescribing errors |
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What were the outcomes from the medical errors evaluated in Family Practice?
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~50% were of no consequence
20% delayed care 10% worsened illness 8% patient upset |
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What are two myths (false) about decreasing the number of medical errors?
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Better prescription writing will reduce number of medical errors (not true, only 8% of errors were related to prescription writing)
Better physician training will eliminate errors (not true, only 8% of errors related to clinical mistakes in knowledge and skill) |
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What are some things that make medicine so susceptible to errors?
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Lack of awareness of the problem
Culture of Silence (blame and shame) System constraints - staffing problems, fatigue, knowledge requirements, communication and continuity of care. |
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What are some recommendations from the National Coordinating Council for Medication Error Reporting and Preventing?
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Make all orders legible, or use order-entry
Prescriptions should include brief note of purpose ("for cough") All orders in metric, except those that use standard units, and units should be spelled out Prescribers should write patient's age and weight Include drug name, exact metric weight or concentration, and dosage form A leading zero should always precede a decimal of < 1 Never use trailing zeroes Avoid abbreviations including drug names (MTX, HCTZ) and latin directions for use (q, od, qid) Use specific instructions (no prn) |
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Catecholamines: Norepinephrine: Applications
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Hypotension (but decrease renal perfusion)
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What sorts of things are important to document in the chart?
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Objective facts
Always date and time Adverse outcomes Disclosure discussions with the patient and names of those present Treatment and followup plans |
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What are barriers to full disclosure in the event of a medical error?
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Psychological
Fear of retribution from patient or their family, from peers, fears of informing them, handling emotions, belief that it is not necessary, belief that something bad would have happened anyway even if not for the error Legal concerns |
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Who gives disclosure of the medical error?
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The attending physician or the physician giving the procedure should disclose the outcome
They may also designate a colleague and make use of case managers, translators, social service workers Consider the event, the degree of harm to the patient and the parties involved |
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How do you prepare to go about informing someone of a medical error/poor outcome?
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Select an appropriate place and time
Position yourself so eye contact is possible Review the facts beforehand and prepare your presentation with another colleague, nurse manager to assess the sensitivity, honesty and appropriateness of what you will say. Identify how you feel about the situation Have a second person present while you concentrate on communicating, so as to independently document and gauge the situation Anticipate the family's possible response |
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When you are disclosing a poor outcome/medical error, what should be kept in mind or done?
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Give a factual statement of what happened in objective terms
Clear conveyance of regret "I am sorry you were harmed..." Steps to prevent recurrence Discussions of changes in plan of care with assessment of understanding As appropriate: offer support services, person to contact for additional meetings, and schedule followup if necessary |
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How do you handle disclosure of confidential information or care provided by another?
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Be polite and do your best with what you can tell them - example: Here is all I can disclose
Care by others: I cannot comment on the care by others but this is being reported to the concerned and they will contact you. |
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What do you do if you are confronted with a patient who wants to file a legal claim?
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Offer to contact your organization's appropriate people for them
Do not offer an opinion on the need for a lawsuit, or a potential dollar amount Notify risk management team immediately Notify your professional liability insurance carrier if necessary |
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How does full, appropriate disclosure of medical errors affect the doctor-patient relationship?
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Despite the fears doctors have that they will be less trusted if they admit error, many patients feel it promotes trust with the doctor and demonstrates respect for patient autonomy and respects the privilege in the relationship.
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So we know communication is one of the most crucial steps in preventing medical errors, so how do you do this with your patient?
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Educate the patient
Print out the AHRQ 20 patient tips fact sheet and give one to each patient As medication history in a specific format: "any OTC, supplements, etc." Coordinate patient care with other medical staff, e.g. consultants, hospital, etc. to make sure information is available at appointments and in emergencies. |
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What are some institutions/organizations/procedures in place to prevent errors?
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Increased Regulations
Industry - leapfrog consortium Private organizations - national patient safety foundation, JCAHO Federal Legislation Learning from other industries Development of IT infrastructures (POE, communication, less reliance on memory) Restriction on working hours Greater staffing to patient ratios, improved nursing jobs Organizational culture |
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What are five patient tips from FDA for patient education?
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1. Speak up if you have questions or concerns
2. Keep a list of all the medicines you take 3. Make sure you get the results of any test or procedure 4. Talk with your doctor and health care team about your options (choices) if you need hospital care 5. Make sure you understand what will happen if you need surgery |
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What is AHRQ?
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Agency for Health Research and Quality
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