MPP2 – Practice lectures 6 & 7Kelly Lefteri

At the end of this session you should be; Able to describe structured consultation

frameworks Aware of professional responsibility to

safety net the patient Able to identify the professional roles and

responsibilities associated with symptom assessment.

In pairs, discuss what your expectations are when you visit a pharmacy?

What are the 3 key activities that must happen?

Where would you like the discussion to take place?

What are your responsibilities?

How are you going to ensure that these are going to be delivered?

Why is it important to do so?

Over the Counter advice Instructions on medicines Health Promotion Ward Rounds Telephone queries

◦ Patients◦ Healthcare Professionals

5

Structured framework for questioning Asks basic information Originally developed for counter assistants

W – Who is the medicine for?W – What is the medicine for?H – How long have they had the symptoms?A – Action already takenM – Medicines taken for other reasons

“Why trusting your pharmacist could put your health at risk”

http://www.dailymail.co.uk/health/article-1077346/Why-trusting-pharmacist-health-risk.html

Which? report

Moving forward need to be more in depth; Symptom analysis

◦ PQRST framework (ordinary or extended)◦ SIT DOWN SIR (Minor illness or Major disease? Ch1)

BUT Not just about questions Listen to needs and concerns Observe for signs of health related issues Ask questions in a non-threatening manner Assess the persons responses

P - Person being treated, are they on any other medicines? (Create a background picture)

P - Provocation or Palliation◦ What caused first occurrence ( onset)◦ What makes it worse?◦ What makes it better, have they tried anything

already? Q - Quality or Quantity

◦ How does the symptom look/feel/sound?◦ How much are you experiencing it now?◦ Have you had it before?◦ Have they tried any medicines?

R - Region or Radiation◦ Where is the symptom located?◦ Does it spread?

S - Severity Scale◦ Severity - How does the symptom rate on a

severity scale from 1-10◦ Course - Is the symptom better/worse staying the

same?  T – Timing

◦ Type/Onset - Did it start suddenly or gradually?◦ Frequency - when and how often does it occur?

(hourly, daily, weekly, associated with meals?)◦ Duration how long does it last?

 U - Underpin concordant relationship◦ Identify treatment priorities◦ Establish what medicines they are going to take

(consider current medication for long term conditions)

  V - Is a visit needed to other

healthcare professional (signposting)?

  W - What public health interventions?

Kurtz SM, Silverman JD, Benson J and Draper J (2003) Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary-Cambridge Guides, Academic Medicine In Press

Processing Skills patient’s narrative question style: open to closed cone attentive listening facilitative response picking up cues clarification time-framing internal summary appropriate use of language understanding patient’s perspective

The bio-medical perspective (disease)◦ sequence of events ◦ symptom analysis e.g. PQRST◦ relevant systems review

The patient’s perspective (illness)◦ ideas and beliefs ◦ concerns◦ expectations◦ effects on life ◦ feelings

Background information - context◦ past medical history◦ drug and allergy history◦ family history◦ personal and social history◦ review of systems

Frameworks for; Handing in a prescription Giving out a prescription Symptoms analysis

Check Studynet Site (MPP2 OSCPE folder)

At the end of this session you should be; Able to describe structured consultation

frameworks Aware of professional responsibility to

safety net the patient Able to identify the professional roles and

responsibilities associated with symptom assessment.