Principles of Patient Counseling
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Complete description and detail of patient's counseling.
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Principles of Patient Counseling
- 1. PRINCIPLES OF PATIENT COUNSELING DR. FARRUKH FINAL YEAR RESIDENT
- 2. Counseling Patient counseling is a broad term which describes the process through which health care professionals attempt to increase patient’s knowledge of health care issues. Patient counseling may be verbal or written performed on an individual basis or in groups & provide directly to the patient or caregiver.
- 3. The process provides for the exchange of information between the patient & health practitioner. The information gathered is needed to assess the patient’s medical condition to further design, select, implement, evaluate & modify health interventions.
- 4. CONSENT The principle that a person must give permission before they receive any type of medical treatment, test or examination.
- 5. TYPES OF CONSENT There are three types of consent: 1. Implied: where the patient’s action or lack of action may clearly indicate their wishes (i.e. – holding out their arm to have a blood pressure recorded). 2. Verbal: a patient may clearly state their consent for a procedure (i.e. – “yes, you can take blood from me”). 3. Written: a patient signs a declaration that they consent to the procedure
- 8. “Nothing travels faster than the speed of light with the possible exception of bad news, which obeys its own special laws.”
- 9. Bad News Any news that drastically and negatively alters the patient’s view of his or her future.
- 10. PATIENT’s AND FAMILY’s EXPECTATIONS Privacy Empathy Dignity Clarity of message Competency Time for questions
- 11. PATIENTS HAVE A RIGHT TO: Accurate and true information. Receive or not receive bad news! Decide how much information they want or do not want. Decide who should be present during the consultation, e.g. Family members. Decide who should be informed about their diagnosis and what information that person(s) should receive.
- 12. RESPONSES TO BAD NEWS Denial Shock Anger Guilt Blame Agitation Helplessness Sense of unreality Misinterpreting information Regret/anxiety
- 13. Do… Ensure privacy and confidentiality Respect Honest Simple language Listen carefully Sensitive to the nonverbal language Allow for silence, tears and other patient reactions Document and liaise with the multidisciplinary team
- 14. Do not… Overload with information Distort the truth Give false reassurance Withhold information Criticize Make judgements
- 17. 1. S: SETTING Arrange for some privacy Sit down Make connection and establish rapport with the patient Manage time constraints and interruptions
- 18. 2. P: PERCEPTION Determine what the patient knows? Listen to the patient! Accept denial but do not confront at this stage.
- 19. 3. I: INVITATION Ask patient if they wish to know? Accept patient’s right not to know! Offer to answer questions later if they wish
- 20. 4. K: KNOWLEDGE Use language appropriate to patient Give information in small chunks Give diagnosis e.g. Cancer Give any positive aspects e.g. Cancer has not spread Check whether the patient understood what you said!
- 21. 5. E: EXPLORE Prepare to give an empathetic response Give the patient time to express their feelings then respond
- 22. 6. S: STRATEGY (SUMMARY) Ask whether they want to clarify something else? Offer agenda for the next meeting e.g. I will speak to you again when we have the opinion of cancer specialist. Close the interview
- 25. COMMUNICATION PLAN Way to go.. Greeting Introduction Ask if patient is comfortable. Sit to right of patient, don’t confront. Inquire and confirm name. Ask if patient knows about reason of meeting. Ask whether patient wants family member or care-giver to be present.
- 26. Find out patient’s knowledge of disease or what they think is wrong. Don’t interrupt patient and let patient finish. Summarize symptoms and disclose diagnosis. Give little time to acknowledge.
- 27. List treatment plan. Tell why surgery or no surgery is best option. What are other options. What will happen if left untreated. Explain type of surgery, its pros and cons. Make a diagram on paper for better understanding. Counsel for possible complications, intra and post-operative or any possible change in plan/approach during the surgery. Mention need for leaving drain in place.
- 28. Ask if patient has understood everything. Ask if patient has any further questions. Tell the patient they can contact you or ward anytime and if need time to consent they can visit in next OPD. Tell patient they can meet with patients in ward who have undergone similar procedures. If planning any instrumentation/implants, give all the details about the post-op care and risks.
- 29. Take consent on paper after asking if they can read and understand the consent or require translation. Thank the patient Say Goodbye.
- 30. SCENARIOS
- 31. Scenario 1 Brain-dead patient on ventilator. Hx of severe head injury.
- 32. Scenario 2 Wrong level laminectomy.
- 33. Scenario 3 Prolactinoma in pregnancy at 30 weeks, with visual loss.
- 34. Scenario 4 Disclosing diagnosis Grade4 Glioblastoma multiforme.