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Solving concerns
1. I can see how much you are worry about your father. We also want to give the best care for your father. But we have a duty to respect patient decision. Without patient's consent, we cannot give treatment against their will even if it is a life saving one. (Competent's patient autonomy outweights beneficience)
2. Mere prescence of blood gases derangement doesn't mean he is not competent. Before making this discussion, my consultant carefully assess your father competency. He is in clear mind. He can understand what we explains, can retain information and judge, and finally make a decision. So, he has full capacity to make a valid decision now. (Assessing competence and valid consent)
3. I am afraid to say that as your father is fully competent, you cannot make decision instead of your father even though you are a LPA. (LPA role in decision making)
4. Regarding with assisted ventilation, your father clearly expressed his wish to the medical team when he has full mental capacity. So, even though he lost his capacity later, you are not legally allow to override and change your father's last decision.
*NB: knowing ethical and legal principles is the key in solving the above concens*
Thank you very much for your active participation. 😍
FYI
Diet 2/2024 PACES application opens from 19 Feb to 26 Feb.
Case scenarios
60 yr man with advanced COPD came with acute infective exacerbation. He is given necessary treatment but still have breathing distress and difficulty. ABG showed pH- 7.3 PaO2- 9.2kPa PaCO2- 7.6kPa.
Your consultant think that there is indications to start NIV and explain this to patient. Patient is now well conscious and fully competent. He decided not to recieve NIV despite he is knowing that it might deteriorate further and might even endanger to his life.
Patient daughter wants to meet and discuss with a doctor.
Patient daughter's concerns are ......
1. Doctors have a duty to save patient's life. Why did you agree to my father decision knowing that it might threaten his life?
2. Are you sure my father is competent as he is now having symptoms and blood gases derangement?
3. Can I request you to put my father on NIV as I am his LPA (lasting power of attorney)?
4. In case my father deteriorate further and lose his capacity, can I decide for him to be treated with assisted ventilation?
1. This rash is medically called psoriasis. It is an inflmmatory skin condition that result in reddening and thickening of your skin.
2. No, it is not a contagious disease. There is no chance of transmission by contact.
3. Let me reassure you that it is not cancer.
4. These rash are controllable and will disappear with appropriate treatment but we cannot say it is cured as it has chance of recurrence.
5. Mostly it will heal without leaving any scar. (As if there is secondary infections or deep traumatized scratch might leave some scars)
* NB. Having adequate medical knowledge is the key in solving concerns in this scenarios *
50 yr man presented with rash on elbows and knees for 1 month.
Petient's concerns are
1. What is this rash?
2. Are there any chance to transmit to my family members if I stay close to them?
3. Do I need to worry about cancer?
4. Will it be cured?
5. Will it leave any scars?
Hope to see your answers soon. 😊
To improve solving concern skill
>>ask concerns actively and listen carefully (always more than 1 concerns)
>>corrrect theroretical knowledge on that point
>>correct understanding of ethical and legal principles
>>good communication skill
>>explain in simple way and in empathy
>>check understanding of patient - does the patient recieve the information you gave correctly
This time we are going to practice on solving concern skill.
To pass this skill, we need to get at least 10 out of 16.
We can get concern skill marks from 2 consultation and 2 communication (4 marks each).
If this CA breast patient on chemo C3 recieved last 7 days,
>>confusion for 2 days
>>preceeding problems with fever, cough and SOB
>>PE - GCS 10/15 no neuro deficit
Harsh VBS with coarse crept in LLZ
👉What is the most likely cause of confusion?
