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

"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."

The purpose of this website is to create a collection of free medical mindmaps in order to facilitate learning of complex topics. Mindmaping is a way of incorporating imagery, colour, and visual-spatial arrangement to your notes. These elements have been separately shown to improve recall of learnt material. Mindmapping allows for the whole topic to be displayed on a single page, which increases revision speed and allows you to see connections between different ideas more easily. The difficulty in using mindmaps for revision is that it often takes a fair amount of time to design them and there are many topics to be covered in medicine. In preparation for exams, it would be very difficult for a student to make a good mindmap for every topic. One of the aims of this website is to help you overcome this problem.

"And yet a lot of people don't know how to listen to someone venting. Usually, people take one of two attitudes. Option 1 is to jump in and give advice -- but this is not the same as listening, and the person doing the venting may respond with "Just listen to me! Don't tell me what to do." Option 2 (usually attempted after Option 1) is to swing to the other extreme, and sit there silently. But this doesn't actively help the person doing the venting to drain their negative emotions. Consequently, it is about as rewarding as venting to your dog."

"Learning is a social, active, and ongoing process. What would a motivated group of self-learners need to know to agree on a subject or skill, find and qualify the best learning resources about that topic, select and use appropriate communication media to co-learn it? Beyond technology, what do they need to know about learning and putting learning programs together? What does a group of people need to know to use today's digital resources to co-learn a subject? This handbook is intended to answer that last question and provide a toolbox for co-learners."

Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. For many, medical professionalism is the "heart and soul of medicine." More than the adherence to a set of medical ethics, it is the daily expression of what originally attracted them to the field of medicine - a desire to help people and to help society as a whole by providing quality health care. But many physicians today experience profound obstacles to fulfilling the ideals of medical professionalism in practice.

"We are sometimes unconscious of the hidden curriculum, but even when conscious of it we are silent or reluctant to act. We need a frank dialogue with students, residents, and each other about the lived experience of a career in medicine as the struggle it often is; about the challenges of living up to our profession's stated ideals; about the dangers of technological expertise without caring human relationships; about conflicts of interest and the difficult professional challenges of dealing with unprofessional colleagues; and about behaviour that imperils patients. We need to add "Above all be not silent" (Primum non tacere)17 to "First do no harm" as tenets to live by, and we must emphasize to students that what they are like as physicians is just as important as what they know. Thus will we build resistance to the hidden curriculum and reclaim our authenticity as trusted generalists whose knowledge is attached to values we truly uphold, model, and reproduce. "

Welcome to doc2doc // Connecting doctors worldwide - doc2doc registration is free and connects you to colleagues around the world. * Get answers to your clinical questions from a community you can trust. * Start a discussion about anything from the latest research to careers advice. * Find colleagues you used to work with. * Create your own online meeting place for your friends, colleagues, hospital or society.

Welcome to doc2doc // Connecting doctors worldwide - doc2doc registration is free and connects you to colleagues around the world. * Get answers to your clinical questions from a community you can trust. * Start a discussion about anything from the latest research to careers advice. * Find colleagues you used to work with. * Create your own online meeting place for your friends, colleagues, hospital or society.

"Which means online assessments could be a boon to your teaching, whether for blended learning, a flipped classroom, eLearning, to better communicate learning progress to parents, or for students to track their own mastery. So then one or two of the 26 teacher tools to create online assessments by Classroomaid Chuang may prove useful to you, yes?"

"It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context."

"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. "

This week when I lead a faculty development workshop* I'll ask participants to consider their readiness to make use of social media. Are you feeling ready, but you wonder how to take the first (or next) steps? Do you want to find out what all the fuss is about? Are you skeptical about mixing social media with your career as a health care professional, medical educator, trainees, and/or student?

"Professionalism in medicine is, in essence, a conversation about what it means to be a good doctor. It has been a major topic of discussion in the field for many years and will likely remain so for years to come. Physicians still debate how to define it, how to assess it and how to teach it. Younger doctors sometimes have different ideas on what it means to be a professional than older colleagues. "

"One of the early tasks is to identify the stakeholders of the resulting Strategic Plan; to identify individuals and groups who will be interested in and affected by the plan, to consider their roles and most appropriate ways and times to communicate with these individuals and groups. A preliminary list has been developed on the wiki; however, to effectively identify all stakeholders another important initial task is to clearly define what is meant by Distributed Medical Education. What is the scope of the plan?"

"Taking a comprehensive social history is time-consuming. It's easy to dismiss the task as outside the doctor's purview, especially when there's precious little time to get through a sea of investigations and treatment options. But every patient is a person, and illness occurs in the context of multifaceted lives. We need to listen to our patients with the recognition that the most important information they can give us about their illness often lies in the folds of their social circumstances. And it's our obligation to tailor our prescriptions to an illness in its full context."

The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system - and with improved outcomes. We asked them about their secret to success. Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there's no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them. If Mayo can do it, why can't everyone else? The AARP believes that the potential is there for most communities to have excellent care - we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It's a big job and will take some investment, but we have many opportunities to do a better job than we're doing today.

Based on the results of this study, the use of social media applications may be seen as an efficient and effective method for physicians to keep up-to-date and to share newly acquired medical knowledge with other physicians within the medical community and to improve the quality of patient care. Future studies are needed to examine the impact of the meaningful use of social media on physicians' knowledge, attitudes, skills, and behaviors in practice.

"The purpose of this article is to argue for the further investigation and revision of these initial attempts to apply checklists to the diagnostic process. The basic idea behind checklists is to provide an alternative to reliance on intuition and memory in clinical problem solving. This kind of solution is demanded by the complexity of diagnostic reasoning, which often involves sense-making under conditions of great uncertainty and limited time."