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General important points in communication
- Get a brief history and ascertain the patient's reasons for coming to clinic
- Get an idea of the patient's undertanding of a disease/procedure
- DON'T assume a patient knows the risks of their disease, e.g. diabetics and eyesight/kidney/vascular damage
Important points in smoking advice
- Find patient's reason for coming in, brief history and diagnosis (e.g. leg pain)
- Talk about risks of smoking to the patient (lungs/heart)
- Find out more about smoking: triggers, barriers to stopping, past attempts
- Benefits of stopping, available support therapy, self help
Information on gastroscopy
- Fast 8-12 hours beforehand with antibiotics and some drugs stopped
- Lasts 10 minutes, but allow 2 hours for appointment
- Anaesthetic spray +/- IV (memory loss). Mouth guard. Pain free normally
- Endoscope thin, flexible tube via mouth. Swallowed.
- Air (image improved) or biopsy may be taken
- No operating machinery <24hrs. Avoid eating/drinking until anaes. wears off
- Results given immediately, unless biopsy or sedated
- Risks = sedative adv. rea. sore throat, teeth damage. Perforation/aspiration pneumonia/IV infection.
- Contact hospital if fever/dyspnoea/haematemesis/pain <2 days after
Information on colonoscopy
- Lasts 30 mins, no driving/machinery <24 hours
- IV sedative to relax, not general anaesthetic
- Air passed into colon. May cause flatus; expected.
- Imaging results given at end unless biopsy. Can bring companion to hear them.
- Pain free, but wind/cramps for hours after. Mild rectal bleeding.
- Risks = significant colonic bleed/perforation
Information on HIV test
- Two blood samples taken: one immediately and another 3 monthsa fter
- If positive, means HIB present and infection risk but NOT defo aids
- If negative, means no Ig found but NOT in the clear due to window period. Patient NOT immune
Taking a sexual history
- Assure confidentiality, including contract tracing and partner notification
- Partners: Sex with men/women/both within 12 months
- Pregnancy: Include desire for or measures to avoid
- Protection: Any protective measures against STDs
- Practices: Oral/anal/"anything else". Performing/receiving
- Past: Sexual history of both patient and partner(s)
Never ever ever say 'loyal' at any point during this consultation
Information on bronchoscopy
- Requires travel to/from hospital
- Lasts 20-30 mins, but 2 hours for appointment
- Thin tube passed down pharynx via nose, biopsy/remove fb
- Requires mild sedation while sitting/lying. No talking
- Mouth+nasal anaesthetic spray or IV (relax). No pain
- Heart rhythm, O2 measured (ECG and oximeter)
- Results given immediately unless biopsy/sedation
- No swallowing after. Always a little blood.
- Risk = sore throat, hoarseness, cough, fever. Pneumothorax/pneumonia
Information on mammogram
- Screening or diagnostic (50-70yrs or Br-Ca/Br-Sur Hx)
- No deodorant/powders/lotion/jewellery worn
- Takes around 30 minutes
- Not given in possible pregnancy or breast feeding
- One breast rested on flat surface and compressed from above - improves image and reducing dosage.
- Uncomfortable. Several angles/postures may be required
- Results sent to patient + GP. If nothing heard DON'T assume its clear.
- Further invest = repeat, US, aspirate or guided biopsy
- 5-15% require further investigation. 30% false +ve
Taking an alcohol/drug history
- Where is the patient in managing problem? Considering stopping/want to but can't start?
- Establish how the problem affects life
- Ever felt the need to cut down?
- Have people suggested cutting down? How did they feel?
- Have they ever felt guilty?
- Have they ever taken the substance to wake up
- Identify something the patient wants but can't have because of problem, e.g. can't visit child
Important points in accessing records
- Data protection act 1998: Right to apply for access to health records/obtain copies
- Freedom of information 2000: Access to all types of records
- Access to Medical Reports Act 1988: Employer has to let patient know if they want records. Patient can refuse but may not be employed. Doctor can amend records if not related to job prospects/incorrect info.
- GP has 21 days to comply to request
- Fee may be required9
What are the Fraser guidelines
- Contraceptive advice and prescription can be given to a minor
- Child must have capacity
- Child cannot be persuaded to tell parents
- Child would continue sex with/without treatment
- Mental/physical health of child at risk without treatment
Describe the right to refuse treatment
- An adult may refuse treatment even if life threatening (if has capacity)
- A minor can consent to treatment if they have capacity, but cannot refuse if refusal would result in death/permanent disability (doctor and court discretion)