Define what is meant by “bad news”?
News that negatively alters the patient’s (or relative’s) view of the future
Doctors may falsely reassure the patient or normalise the consequences of a diagnosis in order to avoid the stress of breaking bad news. What is this called?
Distancing
What are the steps of the ABCDE mnemonic for breaking bad news?
A - advance preparation B - build a relationship C - communicate well D - deal with patient reactions E - encourage and validate emotions
What are the steps of the SPIKES mnemonic for breaking bad news?
S - setting up P - perception I - invitation K - knowledge E - emotions S - strategy/summary
What strategies can be used to deal with patient’s anger?
- recognise/acknowledge the emotion
- remain calm
- do not dismiss the emotion
- apologise / express sympathy
What are the possible immediate manifestations of grief?
- anger
- denial
- fluctuating mood
- depression
- preoccupation
- agitation
- blame
- bargaining
- guilt
- numbness
What information might you gain from a home visit that you might not get from an appointment in surgery?
- is the patient caring for themselves?
- is the patient caring for others?
- do they have support from informal carers?
- indication of SES
- medication management
- do they have adequate mobility around their home?
- is the patient tending to their personal hygiene?
- any signs/indication of abuse
What services might social services provide to a patient who is housebound?
- give information on how to access help and support
- assess whether the patient requires any help with their ADLs
- assess whether the patient is eligible for any financial support
- assess whether the home is an appropriate place for the patient to live / whether any modifications are necessary
- look out for signs of neglect
What services might distract nurses provide to a patient who is housebound?
- assess the need for nursing support
- assess whether OT support is necessary
- assess medication management e.g. flag need for dosset box etc
- discuss patient’s nursing needs at MDT meetings
- administer immunisations
Informal carers may experience adverse effects on their mental and physical health as a result of their caring role. What reasons might there be for this?
- physically exhausted from helping another person with their ADLs
- isolation and carer burden may lead to depression
- less time to attend to their own health needs
- less likely to be in paid employment if providing informal care: poverty can impact on mental and physical health
Define the legal duty of care
A legal obligation on one party to take care to prevent the harm suffered by another
Do doctors have a legal duty of care to patient’s when they are not at work?
- outside of their work environment, doctors do not generally have a legal duty of care - they are not obliged to act as “good Samaritans”
- HOWEVER, if they state they are a doctor or act as if they are a doctor then they take on a legal duty of care for the patient
What three things must be proven for a successful claim of negligence relating to diagnosis or treatment?
- causation
- duty
- breach
How might causation be proved in a negligence claim?
- “but for” test, the claimant must show that , but for the defendants negligence, they would not have come to harm
- the claimant may argue that on the “balance of probabilities” the negligent action caused the harm - requires the claimant to show the harm was more likely to have occurred due to the negligent actions than not
Baby vax: 8 weeks
- 6 in 1: Diptheria, Tetanus, Polio, Pertussis, Hib, Hep B
- Pneumococcal
- Rotavirus
- Men B
Baby vax: 12 weeks
- 6 in 1: Diptheria, Tetanus, Polio, Pertussis, Hib, Hep B
- Rotavirus
Baby vax: 16 weeks
- 6 in 1: Diptheria, Tetanus, Polio, Pertussis, Hib, Hep B
- Pneumococcal
- Men B
12 months vax
- Hib and Men C
- Pneumococcal
- MMR
- Men B
Pre-school booster vax
- Diptheria, Tetanus, Pertussis, Polio
- MMR
Teen booster vax
- Diptheria, Tetanus, Polio
- Men ACWY
Other vaccinations (other than baby vax, 12 month, pre-school and teen boosters)
- HPV (girls aged 12-14)
- flu (eligible paeds groups, disease risk groups, >65s)
- pneumococcal (65)
- shingles (70)
- travel vax
