One of aKind Students
رفتن به کانال در Telegram
2 266
مشترکین
+224 ساعت
+347 روز
+6330 روز
آرشیو پست ها
*invitation (before you tell....ask)
يعني قبل تحكي ليه بالليهو والعليهو اسئلو عايزة يعرف أو لأ
-how much information you want to know
-whould you want to know more details
-offer to answer any questions
*knowledge (expanding the fact)
-give a warning that bad news is coming
- use the same language of your pt
-avoid scientific language
-give information in chunks and ensure understanding
*empathy and emotion
You Must have emphatic response to pt problem and it technique or skill not feeling
-the emphatic response had 3 steps
Step 1........listen and identify the type of emotion
Step2........identify the cause emotion
Step 3....... show that you make connection of the above steps ( l can understand how you can feel)
# type of empathy expression
........non verbal ( eye contact- sit down - relax- touch )
.........verbal" NURSE"
Name the emotion- understand emotion -respect pt and family expression support -explore emotion further
(تتكلم معاه تقوله مثلا انت غضبان و انا بتفهم النقطة وموجود ومعالي باقي التين للمساعدة وتسأله تاني حاسس بشنو وهكذا ...)
*strategy and summary
Decide what is the best treatment plan understanding --summarize the conversation
⭐BREAKS
Background---depth info about pt problem
Rapport----with pt
Exploring -Announce -kindling -Summarize
⭐CONE
Use in flowing situations
1.disclosing medical error
2.sudden deteration of pt condition
3. Sudden unexpected death
Context -opening slot -narrative -emotion -strategy and summary
🔥🔥Reactions can Express by pt
(Crying "offer tissue- break eye contact "- anger -denial- disbelief - numbness -fear -isolation -depression -)
🔥🔥After the interview
(make written record for pt - include the options discussed- future plan
--- number of future meetings
--- follow up
🔥🔥what not to do
--BBN over phone -
--Avoid pt or leave him in suspense
--Lie to pt - Use jargon -interrupt the pt
--say "nothing can be done
--be judgmental - give definite time span to live
--confuse by excessive information
🔥🔥the angry pt
#what to do
-Acknowledge the pt anger
-Try to find out the reason
-Let him ventilate his anger
*sit not too close,too far from pt
Avoid threatening body language
Be aware of your safety
#What not to do
Glare at pt ---confront- -interrupt---touch
--put blame on other
--make unreasonable promise
*BBN over the telephone
Avoid as much as possible
🔥🔥Obstacles to communication of bad news
العقبات
--lack of experience with dying and deaths
-- medical education doesn't teach it enough
-- cultural differences
Lack of trust in medical system
-- unrealistic expectations of health system by society
--no one want to be the bad guy --multiple physician who BBN
--some family don't want pt to know
🔥🔥why it's difficult to BBN
--concern how the news affect the pt
--pt fear of stigma
--fear of being blame
--no want to take away hope
--challeng of delivering news appropriately
🔥🔥why it's important to BBN
-- a majority of patient want the truth
-- may provide level of hopelessness
🔥🔥cause of fear in people with life threatening illness
--fear of pain and dying
--fear of not complete their role
--fear of fear of others
--separation from a loved one or home
--fear of dependence and becoming burden to others
اللهم توفيقك❤️
❄Breaking bad news ❄
بداية أنا م معاطة لكن المحاضرة الماعطة وشكراً 🤣🤣🤣😂
⭐Studies show that discussion of bad news do not met Pt need due to lack of expertise recommendations
⭐Pt with cancer disclose <50% of concern due to inability to communicate with physicians
⭐Pt( 50-90% ) want disclosure
عشان كدا لازم م نخبي على العيان شي
🔥🔥What is Bad news
⭐Any news that seriously or adversely changes Pt's view of his life
⭐SLAI share life altering information
⭐Gap between pt expectations and the reality of medical condition
🔥🔥Examples
_diagnosis at inappropriate time "tremors in cardiovascular surgeon "
_situation where there is "no hope - threat to mental or physical wellbeing- stop life style "
_news of degenerative disorders (Parkinson's disease) -cancer metabolic disorders
_intrauterine fetal death
_failure of medication radiotherapy or poor prognosis" metastasis- relapses"
_amputation of limp
Medical error to pt
_diagnosis of serious sexually transmitted diseases HIV
والأمثلة تطول ........
🔥🔥How to break bad news BBN
(4 strategies to BBN)
1.SPIKES
2.ABCDE
3.BREAKS
4.CONES
*the commonly used SPIKES- ABCDE
⭐ABCDE strategy
A= Advance preparation
B=Bulid therapeutic environment/relationship
C= Communicate well
D=Deal with pt and family emotions
E=Encourage and validate emotions
*advance preparation:
لازم نجهز وضعنا والمكان قبل ما العيان يجي
-be familiarize with the relevant clinical information of pt (investigation -report)
-arrange for adequate time and privacy comfortable environment
-ensure to not interrupt by staff
-Prepare to provide basic information
-write words to be use or avoid
-now your pt (culture - religion)
*build atheraputic environment / relationship :
دي لما العيان يكون قدامك
-introduce to pt and his family
- determine what and how much he want to now
-summarize what happened to date /what happened since the last seen
-give warning shots
-use touch when appropriate
-avoid inappropriate humor
-pay attention to to verbal and non verbal cues
*communicate well :
-speak frankly but with compassion بصراحة بس يكون في شفقة وعطف
determine pt knowledge
-proceeed at the pt place
-allow for silence and tears
-Avoid jargons
-assess the pt understanding
-encourage and answer questions
-provide written information to pt to remember
*deal with pt and family reactions
-assess and respond to emotional reactions
-be empathetic
-be aware of (angry -blame -denial )
-assess suicidal ideation
-allow for shut down when pt cry and stop listening
-if you cry out it under control
- don't argue with and criticize colleagues
ما تتجادل أو تلوم زملائك
*encourage and validate emotions
-offer realistic hope
- encourage about options available and discuss treatment options
-use multidisciplinary services (hospice care- spiritual leader)
⭐SPIKES protocol
It focus on defining the central element of bad news 1.what makes it bad for pt
2. acknowledge pt concern and emotion
S=setting up conversation
P= perception
I= invitation of pt (involve him)
K= knowledge to pt
E= emotions and empathy
S= strategy and summary
*setting
ما بتختلف عن الاستراتيجية القبلها
1-privacy : interview room or office
Turn off TV or radio
2- involve significant others (family or friends)
First ask pt to involve them
They give support to the pt
Reduce stress
3-sit down
Sit down and avoid sitting behind barriers
4. look attentive and calm
do eye contact and break it pt tearful- psycotherapy neutral position -
5- listening mode
(Silence and don't interrupt pt - repeat some of words- nodding- smiling -say HMMM)
6-availability
(Arrange for phone -ensure the staff don't interrupt)
*perception
قبل تحكي للعيان لازم تقيم معرفته وادراكه بحالتو
-Assess pt understanding of the seriousness of his condition and level of understanding
-ask pt and family about everything they known
-watch signs of denial
Don't confrontation the denial because it can lead to antagonistic relationship
بسم الله الرحمن الرحيم
💪على قدر أهل العزم تأتي العزائم....
#Community_department
🌸🌸Communications skills in family medicine🌸🌸
💫Def :
The exchange of messages between people for the purpose of achieving common meanings.
💫Why ?
🔸️The main complaint of patient is related to communication problem not clinical competency...
🔸️The cornerstone for good medical practice
🔸️One of three central elements of doc/pt relationship(communication-continuity , quality of care)
💫💫With poor communication :
⬇️⬇️⬇️
1-Unaware of true diagnosis or
prognosis
2-Uncertain about meaning of or
need for further tests
3- Unclear about management
plans or advice given
4-Confused about the therapeutic
intent of treatment
5-Wanting more information
💫some communication skills :
1.Speaking skills
2. Active Listening
3. Body Language
4. Verbal and Non-verbal encouragement
5. Appropriate questioning techniques
6. Constructive feedback
💫💫outcomes of good
communication:بالنسبه لل
🌸for patients:
Improved understanding
Increased recall of information
Reduced anxiety
Decreased uncertainty
Increased satisfaction
Improved compliance
🌸for doctors :
Accurate diagnoses will increased
Better management decisions
Professionally rewarding
Personally rewarding
Increased satisfaction
💫components of communication:
Sender
Receiver
Message
Feedback
💫Calgray - Cambridge approach to communication skills teaching:
1- initiating the session
2- gathering information
3- building the relationship
4-explaning and planning
5-closing the session
💫deficiencies in communication:
🔸️doctor not obtain enough info about pt
🔸️provide info in inflexible way
🔸️pay little attention in checking how well pt understood
🔸️<1/2 of pt psychological morbidity is recognized
💫problems in communication:
# Shortage of time
Language barrier – low literacy
Firm misconceptions and myths
Lack of awareness
Not ready to take responsibility for patient‟s illness
Socio-cultural, economic barriers
Fatalistic attitude (It‟s God‟s will)
💫barriers to communication:
Personal Barriers
Lack of training: undergraduate/postgraduate
Undervaluing importance of communication
Focus only on treating diseases
Personal Limitations
Organizational Barriers
Lack of time
Pressure of work
💫Reasons for patients not disclosing problem:
Belief that nothing can be done
Reluctance to burden the Doctor
Desire not to appear pathetic or ungrateful
Concern that it is not legitimate to mention them
Doctors‟ blocking behavior
Worry that their fears about what is wrong with them will be confirmed.
# lack of confidentiality and trust.
🔥🔥 والله ولي التوفيق 🔥🔥
بسم الله الرحمن الرحيم
💪على قدر أهل العزم تأتي العزائم....
#Community_department
🌸🌸Communications skills in family medicine🌸🌸
💫Def :
The exchange of messages between people for the purpose of achieving common meanings.
💫Why ?
🔸️The main complaint of patient is related to communication problem not clinical competency...
🔸️The cornerstone for good medical practice
🔸️One of three central elements of doc/pt relationship(communication-continuity , quality of care)
💫💫With poor communication :
⬇️⬇️⬇️
1-Unaware of true diagnosis or
prognosis
2-Uncertain about meaning of or
need for further tests
3- Unclear about management
plans or advice given
4-Confused about the therapeutic
intent of treatment
5-Wanting more information
💫some communication skills :
1.Speaking skills
2. Active Listening
3. Body Language
4. Verbal and Non-verbal encouragement
5. Appropriate questioning techniques
6. Constructive feedback
💫💫outcomes of good
communication:بالنسبه لل
🌸for patients:
Improved understanding
Increased recall of information
Reduced anxiety
Decreased uncertainty
Increased satisfaction
Improved compliance
🌸for doctors :
Accurate diagnoses will increased
Better management decisions
Professionally rewarding
Personally rewarding
Increased satisfaction
💫components of communication:
Sender
Receiver
Message
Feedback
💫Calgray - Cambridge approach to communication skills teaching:
1- initiating the session
2- gathering information
3- building the relationship
4-explaning and planning
5-closing the session
💫deficiencies in communication:
🔸️doctor not obtain enough info about pt
🔸️provide info in inflexible way
🔸️pay little attention in checking how well pt understood
🔸️<1/2 of pt psychological morbidity is recognized
💫problems in communication:
# Shortage of time
Language barrier – low literacy
Firm misconceptions and myths
Lack of awareness
Not ready to take responsibility for patient‟s illness
Socio-cultural, economic barriers
Fatalistic attitude (It‟s God‟s will)
💫barriers to communication:
Personal Barriers
Lack of training: undergraduate/postgraduate
Undervaluing importance of communication
Focus only on treating diseases
Personal Limitations
Organizational Barriers
Lack of time
Pressure of work
💫Reasons for patients not disclosing problem:
Belief that nothing can be done
Reluctance to burden the Doctor
Desire not to appear pathetic or ungrateful
Concern that it is not legitimate to mention them
Doctors‟ blocking behavior
Worry that their fears about what is wrong with them will be confirmed.
# lack of confidentiality and trust.
🔥🔥 والله ولي التوفيق 🔥🔥
. بسم الله الرحمن الرحيم
#Community_department
#Family_Medicine
🛑اولا نعرف ال family medicine 💊:
_ medical speciality which provides continuing and comprehensive health care for individual and family .
_ integrated clinical, biological and behavioral sciences .
🛑 Family physician :
Physician who trained and educated in the discipline of family medicine.
🛑 family practice :
Is used to indicate the services part of the specialty .
🛑🛑🛑⭕️
Principles of the family medicine:
1_ family physician is a skilled clinician .
2_ family physician is a resource to a defined practice population.
3_ family medicine is a community based discipline.
4_ patient_physician relationships is central to the role of the family physician.
⭕️⭕️⭕️⭕️⭕️🛑
Characteristics of general practice/family medicine:
1_ General :
ما بختار بروبلم معينه ولا عمر أو جنس او دين او عرق معين . هو unlimited
2_ Continuous :
longitudinal health care , not limited to one illness episode.
3_ Comprehensive : integrate
_ health promotions, prevention , curative , Rehabilitation.
_ physical, psychological, social
_ clinical , ethical
4_ Co_ordinated :
Care managed at first contact , referral if need .
5_ Collaborative:
_working in multidisciplinary teams .
6_ Community and family based.
7_Evidance based health care
8_ Accessibility care
9_ Central patient doctor relationship.
الفرق شنو بين ال family medicine و ال general practice ⁉️⁉️
_ General practice (GP) : disease oriented ( based on episodic care ) .
_ family medicine: patient centered ( offer continuing comprehensive health care ) .
⛔️⛔️⛔️ Competencies of family physician:
1_ Ability to manage acute and chronic health problem.
2_ Ability to provide health promotion/preventive services.
3_ provide emergency service
4_ counselling and home care services.
ركزوا مع العنوان الجاي دا م نفس الفات، الجاي دا خصائص ال competent FP 🙂🔥
⭕️⭕️ Characteristics of competent FP :
1_ competency in Dx, Rx of common health problem.
2_ improving quality of care .
3_ Identify the need of the community .
4_ Ability to communicate efficiently.
5_ Ability to Carry out studies and Research.
6_ Ability to plan and implement action plan .
7_ Ability to refer patient when it needs
8_ motivation of community to practice health behavior.
🛑🛑 نجي نفرق بين ال FP و ال other physician :
1_ frist contact
2_ provides continuity of care
3_ provides comprehensive care .
4_ use holistic approach .
5_ shared care.
6_ patient centered approach.
7_ care for all , care at all time , care at any place .
8_ proper utilization of service.
9_early diagnosis and management
⚡️⚡️ family is a functional unit of the community.
Characteristics of family:
1_ living in the same house.
2_ share values and norms
3_ share similar social activity
4_ having similar schooling / similar experience of success and failure.
➡️ function of family:
1_ care ( support , emotional)
2_Affection
3_ provide status( education, economic)
4_ reproduction
5_ socialization .
Finally......🔥🔥🔥🔥🔥🔥
⚡️Family in family practice:
1_ family is unit of health care in F practice.
2_ family could be source of health or illness.
3_ has important role in prevention and promotion of health .
4_ has important role during illness.
5_ family could be a source of stress
6_ family could be good source of stress management.
_لا إله إلا أنت سبحانك إني كنت من الظالمين _💙
بالتوفيق 🔥
Concept of Health
#Cocepts_of_health :
-Biomedical concept
-Ecological concept
-Psychological concept
-Holistic concept
1. Biomedical concept :
{ The absence of disease }
2. Ecological concept
{Equilibrium between human being and environment}
3. Psychological concept
{ health is influenced by social ,psychological ,cultural ,economic and political factors }
4. Holistic concept
{health is multi-dimensional process involving the well being of whole person in context of his environment }
#Dimensions_of_health :
-Physical
-Mental
-Social
-Spiritual
1. Physical Dimension :
-is the state in which every organ and every cell is functioning at their optimum capacity and in perfect harmony with the rest of the body .
#NOT :
Physical Dimension is assessed at the community level by the #measurement morbidity and mortality .
2. Mental Dimension :
-is the ability to think clearly and cohorently .
#Definition :
-Mental health : is a state of balance between the individual and the surrounding world and #not merely the absence of mental illness .
3. Social Dimension :
-is the ability to make and maintain relationship with other people or communities .
4. Spiritual Dimension :
-connected with religion beliefs and practices .
#Definition :
-Disease : is any deviation from normal functioning or state of complete physical or mental well being .
_______
Distinction between ,Disease ,illness and sickness :
#Disease :
-there is some thing wrong with body function .
-can be psychological or physiological
#illness :
-State of person who feels aware of not being well ,with the presence of specific disease .
#sickness :
-State of social dysfunction .
________
The concept of #Well-being is expressed as :
1. Standard of living
2. Level of living
3. Quality of live .
#Components_Of_Well-being :
A. Objectives :
{standard of living or level of living}
B. Subjective :
{Quality of life}
______________
#Aspects_Of_health :
Are :
1. Subjective :
-formed by sensations and feelings of a person suffering from disease .
2. Objectives :
-formed by objective parameter obtained by measurement of structures and functions of a person during disease .
#NOT :
-the #Quality of living can be #evaluated by assessing the persons subjective feeling of happiness or unhappiness about the various life concerns .
____________
3.1.2022
Concept of Health
#Cocepts_of_health :
-Biomedical concept
-Ecological concept
-Psychological concept
-Holistic concept
1. Biomedical concept :
{ The absence of disease }
2. Ecological concept
{Equilibrium between human being and environment}
3. Psychological concept
{ health is influenced by social ,psychological ,cultural ,economic and political factors }
4. Holistic concept
{health is multi-dimensional process involving the well being of whole person in context of his environment }
#Dimensions_of_health :
-Physical
-Mental
-Social
-Spiritual
1. Physical Dimension :
-is the state in which every organ and every cell is functioning at their optimum capacity and in perfect harmony with the rest of the body .
#NOT :
Physical Dimension is assessed at the community level by the #measurement morbidity and mortality .
2. Mental Dimension :
-is the ability to think clearly and cohorently .
#Definition :
-Mental health : is a state of balance between the individual and the surrounding world and #not merely the absence of mental illness .
3. Social Dimension :
-is the ability to make and maintain relationship with other people or communities .
4. Spiritual Dimension :
-connected with religion beliefs and practices .
#Definition :
-Disease : is any deviation from normal functioning or state of complete physical or mental well being .
_______
Distinction between ,Disease ,illness and sickness :
#Disease :
-there is some thing wrong with body function .
-can be psychological or physiological
#illness :
-State of person who feels aware of not being well ,with the presence of specific disease .
#sickness :
-State of social dysfunction .
________
The concept of #Well-being is expressed as :
1. Standard of living
2. Level of living
3. Quality of live .
#Components_Of_Well-being :
A. Objectives :
{standard of living or level of living}
B. Subjective :
{Quality of life}
______________
#Aspects_Of_health :
Are :
1. Subjective :
-formed by sensations and feelings of a person suffering from disease .
2. Objectives :
-formed by objective parameter obtained by measurement of structures and functions of a person during disease .
#NOT :
-the #Quality of living can be #evaluated by assessing the persons subjective feeling of happiness or unhappiness about the various life concerns .
🔆Screening:-
▪️All pt > 18Y check at least every year
▪️All pt with risk factor or systolic BP 120_130 must be check every 6month
💙💙سبحانك اللهم وبحمدك نشهد أن لا إله إلا أنت نستغفرك ونتوب إليك💙💙
موفقين في آخر امتحان في البيزيك ومرحبا بمرحلة الكلينك🌸💙
