Group items tagged

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"The Patient Safety Curriculum Guide provides teaching and information tools to support patient safety learning. The Curriculum Guide comprises two parts. Part A is a teachers' guide designed to introduce patient safety concepts to educators. It relates to building capacity for patient safety education, programme planning and design of the courses. Part B provides all-inclusive, ready-to-teach, topic-based patient safety courses that can be used as a whole, or on a per topic basis. There are 11 patient safety topics, each designed to feature a variety of ideas and methods for patient safety learning. "

"Narratives have always been a vital part of medicine. Stories about patients, the experience of caring for them, and their recovery from illness have always been shared-among physicians as well as among patients and their relatives. With the evolution of "modern" medicine, narratives were increasingly neglected in favor of "facts and findings," which were regarded as more scientific and objective. Now, in recent years medical narrative is changing-from the stories about patients and their illnesses, patient narratives and the unfolding and interwoven story between health care professionals and patients are both gaining momentum, leading to the creation or defining of narrative-based medicine (NBM). The term was coined deliberately to mark its distinction from evidence-based medicine (EBM); in fact, NBM was propagated to counteract the shortcomings of EBM.1,2 But what is NBM? Is it a specific therapeutic tool, a special form of physician-patient communication, a qualitative research tool, or does it simply signify a particular attitude towards patients and doctoring? It can be all of the above with different forms or genres of narrative or practical approach called for depending on the field of application. "

"To describe the essential components of the medical model of substance use disorders. To delineate the interviewing skills necessary to screen effectively for substance use and abuse. To understand the high rate of psychiatric and medical co-morbidity and more effectively screen patients for these disorders. To demonstrate skills for evaluating patients' stage of change, readiness to accept the diagnosis, and readiness to undertake behavior change. To clearly and supportively recommend treatment to patients with substance use disorders. To describe the skills required for addiction prevention counseling. To define the skills that help set respectful limits on patient requests for prescription medication. To demonstrate awareness of how physician/clinician attitudes toward patients with substance use disorders impact recognition, diagnosis, and treatment of patients. To demonstrate knowledge of substance use disorder treatment standards and the ability to recommend appropriate referrals."

"Yet the presence of a computer in the examination room and the pressure to document the visit in the EHR are often perceived as adversely affecting the patient-physician interaction. How can the EHR instead have a positive effect on this interaction and promote patient activation during the course of the outpatient visit? When clinicians invite patients to view the computer screen and parts of their electronic chart, it not only avoids uncomfortable periods of idle silence that sometimes accompany EHR-related tasks, but it may enhance the relational aspect of patient-physician communication in a way that fosters patient activation in real time."

"Medical schools and Continuing Medical Education should focus on training programs for recognizing and handling linguistic barriers between physicians and patients. Patient education programs should encourage patients who experience language barriers to open up to physicians. In situations where language is a barrier, physicians and patients should be encouraged to use interpreters to enhance the expression of emotions."

"This study indicates that, even though third-year students may have adequate general interviewing skills, they may need additional training and practice in obtaining contextual information about patients in all clinical settings. These findings also suggest that the gender of the patient, as well as gender concordance between patient and student, play a role in student-patient interactions."

VideoMD was created by physicians, for physicians and their patients. Our mission is to strengthen the relationship between doctors and their patients. Using contemporary technology to help physicians fully educate patients on their specific healthcare concerns, the bond between doctor and patient will be changed forever.

"These patient decision aids (PDAs) have been developed to help support difficult decisions in which patients need to consider benefits versus risks. Decision aids prepare patients for decision-making by increasing their knowledge about expected outcomes and personal values. The PDAs are based on the best available evidence but are not a substitute for a discussion with a suitably skilled healthcare professional. We hope that their use in such discussions will result in better informed, patient-focused decision-making. "

"From previous work, including a well-regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was just discussed less than 2% of the time. "Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants.""

"Today, most patients with cancer never receive information from their physicians about their prognosis or even imminent death. According to a recent article in The Journal of the American Medical Association, not telling patients their prognosis leads to a worse quality of life for both patients and their caregivers."

"Teaching hospitals the world over face increasing difficulties in sourcing real patients who exhibit every conceivable ailment which medical students need to learn to diagnose and treat. An e-learning approach using interactive computer simulations known as virtual patients is one way to solve the problem, but in which settings is the use of these virtual patients most effective?"

"Welcome the eViP website! This site is dedicated to bringing you information about the eViP programme, a collaboration between nine universities and MedBiquitous Europe. eViP aims to create a bank of 320 repurposed and enriched virtual patients. These virtual patients will be available under a Creative Commons Licence. All virtual patients are repurposed using MedBiquitous Virtual Patient Technical Standards."

"During the 2-year period, 4282 patients were registered for the service. Patients made 2531 online visits, and billings were made for 1159 patients. E-visits were submitted primarily by women during working hours and involved 294 different conditions. Of the 2531 e-visits, 62 (2%) included uploaded photographs, and 411 (16%) replaced nonbillable telephone protocols with billable encounters. The e-visits made office visits unnecessary in 1012 cases (40%); in 324 cases (13%), the patient was asked to schedule an appointment for a face-to-face encounter. "

"Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients. "

"Welcome to Patient Pictures - clear, accurate clinical drawings with explanatory notes to help you explain medical conditions, tests, treatments and procedures to your patients. Each page can be viewed on screen, printed out or e-mailed to patients or carers as follow-up information. "

"Welcome to the Virtual Interactive Case (VIC) system for creating simulations of encounters with patients in clinics. VIC cases are clinical reasoning exercises with feedback. Their role is to provide a bridge between theory and seeing patients in clinic (or ER), providing students with what Ericsson has called "deliberate practice" as a way of gaining clinical expertise. The strength of VIC is that it is optimized for rapidly creating a large number of cases, by using a patient template, and creating variations of cases with different differential diagnoses for the same presenting complaint."

"The Institute for Innovative Technology In Medical Education (iInTIME) meets its mission by collaborating to develop and then distribute virtual patient cases and other on-line educational modules that are consistent with iInTIME's educational philosophy. These virtual patient cases harness the power of medical knowledge and are designed to supplement traditional clerkship teaching and patient care activities for third-year medical students, but also are appropriate for many other learners."

"It's not just patients who can learn from tools that help them make evidence-based decisions. Assessing patients' understanding of the information provided and the reasons for their health care choices has been an educational experience for Dale Collins Vidal, MD, director of the Center for Informed Choice at Dartmouth Medical School in Hanover, New Hampshire."