9.18 Lecture Notes PDF

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Byrnes; Exam 1...

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1st thing required to do 1. Initial assessment (foundation of treatment plan) - 1st time you meet patient ● Diff. for each field, which you learn in professional school (what you’re required to assess) ● Required by licensure boards (aka is legal) {reason why we can’t diagnose over the phone} ● Gathering pt info ○ Relies heavily on skilled observation (aka understanding what you’re looking at) ■ Hard to train (in school, minutely pointed out and you’re tested over it) bc nothing is black and white; reading from book is diff. From actual pts.; can’t call back pt if you missed anything; also hard to change the amount of awareness a person has ■ In school, 1st didactic, 2nd diagnosing fake pts with nearby teacher, 3rd diagnosing but teacher is away (not telling you what you missed) ● Also need active listening (following what pt says, trying to understand, asking qs if not understanding, clarify, body language ■ Pts have many ways of describing pain (which we can’t diagnose a progression) so we have a scale (1 - 10, 1 is lowest and 10 is the highest) ● If pt says 11, you ask do we need to call 911? Pts usually change answer after this ● ***document if pt talks about pain ● Have to get info in an objective manner - not implying anything, putting any layers, don’t filter what pt says and just write what he/she says; don’t have opinion ● Skilled observation - watch the pt when they leave ○ This is used to catch druggies, goes into more detail in health school ○ Red flags - pts say specific meds, doesn’t want alternate treatment plans, continuously comes but doesn’t get better, gets meds from multiple doctors ○ There are druggie pts in all healthcare fields ○ Can document “I observed pt leaving fine, bending, etc.) ● Have to focus on pt’s strengths for treatments and meeting (easier to motivate and gives you something to build-on) ● Required by JCAHO and payer sources that we document how we explained procedures, meds, pt edu, diagnosis, how pt responded, future anticipated training (think about complete cycle of treatment) ○ Do they understand, do they ask lots of qs (you have to change q to get needed response) ● If it’s not documented, it never happened ● If working as part of team, document if you consulted someone for same pt OR basing treatment on what someone else said (***) ● When assessing, have to look at… ○ Intrinsic factors : within; pain ○ Extrinsic factors: outside; levels of sppt, reinforcement pt has, motivation, or can be negative Patient Motivation ● Big factor is doc ● Break down recommendations in understandable manner

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Sequencing - we explain treatments (procedures in specific sequence so they understand why they have to do it) ○ What is it going to show, body affected, how it’d help to diagnose ○ Ex. hip replacement pt doesn’t understand why they’re doing exercises not related to hip If pts don’t ask qs, doesn’t mean they understand everything ○ You could give qs to pt or “is there anything that i’ve talked about that you would like me to explain further?” ■ Don’t make em feel stupid Scare tactics don’t work but lots of doctors think it does Acknowledges that some of the stuff is anxiety provoking, ○ “I understand you’re nervous”, talk to ‘em bc they won’t do it Many pts believe that their future is predetermined (belief that doesn’t matter what they or you do, outcome will be the same), culturally based, and these pts will pick and choose and will have bad outcomes and then show you that it happened ○ Can’t document the term, but rather “pt says that their health status is predertmined” Ex: pt’s husband brings her in bc she’s giving away possessions and getting parents to be guardians of her kids. This is bc she thought that she’d die at 35 from breast cancer just like her mom did, regardless of lack of evidence of it happening Everyone dies eventually but we don’t live in constant fear Hidden agendas/ulterior motives regarding medical conditions: pt discovered that if you’re sick you’ll get “rewarded” (ex. Workers comp, attn from friends and family, and not having to do anything) ○ These pts ar scary bc they make-up info that you “said” to their family (it’s not as serious as they make it out to be) ○ National situation bc they can make up symptoms and gets workers comp.; employer will ask you for letter but NEVER write letters for pts who have been faking a condition bc then you’ll be accused of helping the pt being fraudulent...