CS2_Exam One
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Wayne State University *
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MISC
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Health Science
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Jan 9, 2024
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Clinical Skills 2 – Exam One 1.
Define HPI and discuss its purpose è
Amplifies the chief complaint & describes how each symptom developed è
Includes patient’s thoughts, feelings, effects on life, etc. 2.
Discuss the components of the HPI è
Onset, frequency, location, quality, quantity, setting, timing of the symptom, alleviating and aggravating factors, associated symptoms, patient perspectives è
WWQQAA+B 3.
Decide which data should/should not be included in the HPI è
May/should include: medications, treatments, allergies, tobacco/alcohol use o
Medications = Rx, OTC, alternative, since when, dosage, frequency, etc. è
Should include pertinent positive & negative findings (i.e. cough w/ phlegm OR cough does not have phlegm) 4.
ID the proper format in writing the HPI è
Clear, chronological order written in paragraph format è
Must be accurate, concise, and complete 5.
Define PMH and discuss the purpose of it 6.
Discuss the components of the PMH & decide which data should/should not be included è
Childhood history = diseases, hospitalizations, vaccinations è
Adult history = diseases, hospitalizations, operations, vaccinations, screening tests è
Injuries/accidents è
Blood transfusion è
Mental health è
Allergies è
Other medications è
Obstetrical & menstrual history = age of onset, duration, cycle, flow, OB score, contraceptives, deliveries, etc. 7.
ID the proper format in writing the PMH è
Not in paragraph form – it is just listed in bullet form 8.
Define FH & discuss its purpose è
Enquiry into diseases that present in the family & might affect the patient’s health è
Although you may already have an idea of diagnoses, the FH can provide other info or indicate risk factors for certain diseases 9.
Discuss the components of the FH & which data should/should not be included è
Hereditary diseases, familial illnesses, current/recent sickness in family, social habits 10.
ID the proper format in writing the FH è
Written in bullet form 11.
Describe all process skills used in the interview and determine which skill best facilitates the interview after patient responses OB
sore
G-
p
-
CFPAL
)
è
Gives appropriate non-verbal cues, picks up on non-verbals, appropriate communication, summarizing/checking for accuracy, logical structure and timing, support and concern, etc. 12.
List the specific areas of questioning and cite examples of questions when asking about “family status and relationships” and about “home situation” è
who lives with you in your home? Are you in a relationship/married – and how long? are there any children living in your home? What is the support system like in your household? è
Tell me about your home situation (type of housing, location of housing) è
Are there any problems or stressors with your housing? 13.
ID key concerns when asking about employment, education, and health literacy & use appropriate questions è
Are you working now? Tell me about your job/daily work è
Have you ever served in the military? è
Are there any stressors in your work at this time? è
Tell me about your schooling/education. How happy are you with how well you read? 14.
ID key concerns about sleep, diet, and financial concerns & use appropriate questions è
Do you have any concerns about affording your health care? è
Tell me about your normal diet. Do you have any restrictions? Do you consume enough water? Allergies? è
What’s your average number of hours of sleep per night? Do you wake up refreshed? Any problems falling asleep or staying asleep? 15.
Describe an “explanatory model” and how it was assessed è
Refers to how the patient explains their illness to themselves è
Partially derived from asking the patient their perspective: “what do you think might have caused the problem?” è
This is important because it will influence how they’re going to respond and try to get well 16.
Assess sleep and make a statement about the patient’s sleep and risks in a note è
There’s a wide range of sleep time that’s considered “normal” but ~7.5hrs is the standard è
If patient feels refreshed & awake throughout the day after 6 hours, then they don’t need more sleep è
If patient needs 9 hrs/night to feel refreshed then the 7.5 is not enough 17.
ID potential hazards in the patient’s life è
Are you being exposed to any kind of environmental hazards? è
Do you use any safety measures such as seat belts, smoke detectors, sun screen? 18.
Describe what is meant by complementary, alternative, and integrative medicine and ID some common alternative & complementary practices used in the US è
CAM = complimentary and alternative medicine è
“
complementary medicine
” = use of CAM together w/ conventional medicine e
If
acvpuntvre
to
help
wl
side
effects
of
cancer
treatment
è
“
alternative medicine
” = use of CAM in place of conventional medicine è
“
integrative medicine
” = combines treatments from conventional medicine and CAM for which there’s some high-quality evidence of safety and effectiveness è
CAM Therapies: acupuncture, hypnosis, meditation, naturopathy, tai chi, qi gong, chelation therapy, deep breathing exercises, homeopathic treatment, massage, yoga 19.
Describe a basic screening protocol for assessing domestic violence when taking the social and personal history è
SIGNPOST: “because abuse is common in many patient’s lives, I’ve begun to ask about it routinely. In the last year, have there ever been times that you do not feel safe at home?” o
If patient says they don’t feel safe or is considered high risk due to their history, signs, symptoms, or any red flags then follow up w/ the PEACE or HITS questions 20.
ID indicators and red flags for the possibility of domestic violence and determine when to use screening questions è
Unexplained injuries or inconsistent w/ patient’s story è
Injuries cause significant embarrassment or reluctance to speak è
When the patient or someone close to them has a history of alcoholism/drug abuse è
When spouse or other accompanying person tries to dominate the interview, is anxious, or controlling 21.
Describe what happens in the interview if the patient says they do not feel safe at home è
Follow up w/ the PEACE or HITS questions è
HITS = hurt, insult, threaten, scream 22.
Determine when to use PEACE questions and how they’re asked è
P: have you ever been in a relationship in which you’ve been
physically
hurt by a partner or someone you love? è
E: have you ever felt you’re walking on eggshells
to avoid conflicts w/ a partner or loved one? –
start w/ this question, then go in order**
è
A: have you ever been sexually abused
, threatened, or forced to have sex, or participate in sexual practices when you did not want to? è
C: has your partner/loved one tried to control where you go, what you do, and who you talk to or who your friends are? è
E: have you ever been emotionally abused or threatened by a partner or loved one? 23.
ID which of the 5 stages of change a patient is showing è
Pre-contemplation: not currently considering change o
Validate lack of readiness, encourage re-
evaluation/self-exploration, explain and personalize the risk è
Contemplation: ambivalent or not considering change within the month treating
heart
disease
"
WI
chelation
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o
Validate lack of readiness, encourage evaluation of pros/cons, ID/promote new and positive outcome expectations è
Preparation: some experience w/ change, trying to change or planning to act within the month o
Identify and assist in problem solving, help ID social support, verify patient has underlying skills for change, encourage small initial steps 24.
Use the OARS techniques è
O: open ended questions è
A: appreciate è
R: reflect è
S: summarize 25.
Explain the A’s of ask, advise, assess, and assist for a patient who’s trying to quit smoking è
Ask:
“Do you smoke?” at every visit, even after they quit è
Advise
them to quit smoking at every visit. Be clear, strong, and personal. è
Assess their readiness to quit by asking them if they want to quit. Find out what stage they’re in by asking for them to rate the importance, and pros/cons, etc. è
Assist
them w/ a plan if they’re ready to quit. Keep the conversation active and keep the patient thinking about the behaviour. Make a quit date and use self-monitoring and goal setting. è
Arrange follow up if possible 26.
Determine the risks of caffeine consumption and apply to the concept of dose dependence. è
A dose of 300mg does NOT act as a positive reinforcer and can produce increased anxiety and mild dysphoria (average intake is 200-250mg/day = 2 cups) è
Even higher doses produce confused thinking, rambling speech, marked agitation, and mild visual hallucinations è
Risks of caffeine consumption are dose-dependent: o
Gastric ulcers, trigger coronary/arrhythmic events, side effects on fetus, headache, anxiety, tremors, insomnia o
Cancer may be associated but data is lacking o
Long term = generalized anxiety disorder, depression, and substance abuse disorders è
Caffeine shots have tons of Vitamin B, which could possibly be overdosed on if not enough H2O is consumed 27.
Calculate pack years & explain to a patient è
One pack = 20 cigs è
Pack years = (# of packs/day) x (years of smoking) è
Measurement forms an international standard used to determine tobacco exposure & is used in two ways: o
Smoking risk appraisal o
Determine association or causality w/ specific smoking related diseases
è
Incidence of lung cancer is strongly correlated w/ smoking, and this risk increases w/ the # of cigarettes smoked over time è
> 30 pack-year histories have the greatest risk for developing lung cancer o
Among those who smoke 2 or more packs/day, 1 in 7 will die of lung cancer è
Helps put the patient’s risk in the proper perspective 28.
Provide appropriate medical advice concerning nicotine & alcohol use è
“Quitting tobacco is the most important thing you can do to protect your health. I strongly recommend that you consider quitting, and I am willing to assist you in this” è
Assess the patient’s readiness to quit through MI è
Clinical trials have demonstrated that brief interventions promote significant, lasting reductions in drinking levels of “at-risk drinkers” who are not yet showing signs of alcohol use disorder; even if they don’t accept a referral, repeated alcohol-focused visits w/ a health care provider can lead to significant improvement
29.
Determine the risk for male & female patients in terms of the amount of alcohol consumed & pattern of consumption è
All heavy drinkers have a greater risk of: hypertension, GI bleeding, sleep disorders, major depression, hemorrhagic stroke, cirrhosis of liver, several cancers è
Heavy alcohol use commonly INDUCES: cardiac arrhythmias, depression, irritability, trauma, sexual dysfunction, dyspepsia, anxiety, insomnia, headaches è
Drinking becomes too much when it causes/elevates the risk for alcohol-related problems or complicates the management of other health problems o
Men who drink more than 4 standard drinks/day (or >14/week) o
Women who drink more than 3 drinks/day (or >7/week) 30.
ID early symptom patterns shown by patients w/ alcohol use disorder è
Headaches, early morning awakenings, GI problems, irritability, inability to focus è
9/10 primary care physicians in US fail to correctly diagnose alcohol use disorders, even when their adult patients present w/ these symptoms 31.
Use CAGE screening questions è
Used for drug & alcohol use – used on each substance to determine how the substance is affecting the patient’s life è
C:
have you ever felt you need to CUT down on drug use? è
A
: have people ANNOYED you by criticizing your drug use? è
G
: have you ever felt GUILTY about your drug use? è
E
: have you ever had a drink/substance first thing in the morning to steady your nerves or get rid of a hangover (EYE opener)? è
If yes to any of these 4 questions… o
Do you use any other drugs than those prescribed by your physician? o
Has a physician ever suggested that you might cut down or stop use of any substances? o
Has your drug use ever caused you any family/work/legal problems? o
When using drugs have you ever had a memory loss or blackout?
32.
Use best-evidence screening questions that will best assess use of illegal drugs & non-
medical use of prescription drugs è
“How many times in the past year have you used a recreational or illegal drug?” è
“How many times in the past year have you used a prescription medication for non-
medical reasons/that was not prescribed to you?” è
It’s best to ask these questions in a way that assumes the patient is using (i.e. instead of saying “have you” you say “how many times have you”)
33.
List the types of drugs that are typically screened & questions that follow a positive response è
Opioids, CNS depressants, benzos, barbiturates, stimulants è
Rx Stimulants: ritalin, concerta, dexedrine, adderall, diet pills è
Rx Opioids: fentanyl, oxycodone, hydrocodone, methadone, buprenorphine è
Rx Sedatives: valium, Ativan, Xanax 34.
Respond to questions about confidentiality & reason for assessing drug use è
Assessing to help better understand your patient’s overall health & risk factors in order to better help diagnose & treat them è
Everything will be completely confidential, unless there is risk of danger being posed to the patient or someone else 35.
Define collusion & ID any of the 3 types of collusion è
When a physician somehow merges with their patient’s view of themselves and the world instead of helping their patient deal with it è
A valuable opportunity to help may be totally lost è
Physician buys the patient’s story about not being able to cope with things and fails to help the patient discover how they no longer need to be a prisoner of that story è
Lack of challenge, reluctance to give rational feedback, softening of accountability o
Can also occur when physician over-identifies w/ their patient
or patient’s experience 36.
Describe examples of empathy w/out collusion è
See the problem from the patient’s perspective, then communicate your understanding back to the patient. Offer support through concern, understanding, willingness to help. Acknowledge coping efforts & appropriate self-care. Remain sensitive. è
Sympathy is a feeling of pity or concern from outside of the patient’s position 37.
ID and differentiate between primary & secondary appraisals è
Appraisal = when a stressor occurs, an individual determines whether or not there will be a stress response, and if so, how intense it will be è
Primary Appraisal – regarding the stressor: is this stressor something I need to worry about? Is it a threat? è
Secondary Appraisal – assess coping resources: given this stressor, do I have enough energy/support/resources to cope with it adequately?
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38.
Describe the impact of the primary & secondary appraisal on the patient’s stress response è
If a stressor is deemed very important/threatening and coping resources are seen as deficient, the negative stress response will most likely be significant è
The appraisals determine whether or not we actually become stressed è
Negative stressors are: negative, ambiguous, threatening, uncontrollable, novel, chronic, central to the life values of the patient 39.
Describe the biology & function of strong emotions such as anger & sadness è
Normal & to be expected when humans face traumatic crises or lifechanging events; can originate in the patient or clinician è
Our reasoning is governed by our emotions & desires much more readily than they are by logic or rationality è
We consider ourselves rational beings, but human behaviour is often driven more by emotion than logical thought – when people are in highly emotional states, their ability to use cognitive reasoning is compromised è
Expressions of empathy, both verbal and nonverbal, are the most effective ways to connect w/ them è
People/primates have evolved the capacity to read others’ emotions à
implies that empathy provides a survival advantage o
Research w/ chimps shows social advantages w/ reading emotion & disastrous consequences for those unable to do so è
Mirror neurons allow us to imagine other peoples’ experience à
complex neurobiological & neuroendocrine mechanisms è
Emotional intelligence (EQ) may correlate better w/ job/marital success than IQ 40.
Describe how to respond to the strong emotion of sadness è
Responding to emotions empathically strengthens the clinical alliance and promotes healing – learning to respond skillfully can promote personal & professional growth è
Awareness of emotions & being able to recognize them allows us to react mindfully, rather than reflexively è
Empathic imagining of what a patient is going through & active expression of this allow us to stay w/ patients where they are emotionally è
Emotions of sadness, fear, and anger have origins in the experience or anticipation of loss – can assess by asking yourself “what was threatened?” o
Sadness = patient experiences the discrepancy between a desired and an actual state §
Gentle exploration is more effective than trying to reassure
; give the patient control over whether and how to discuss the emotion §
Should NURS the patient – sometimes just naming the emotion can help §
If the patient is sobbing, say something like “can you tell me what is upsetting you?”
o
Fear = patient confronts the agent of an anticipated loss o
Anger = fights back against threat §
Secondary emotion because underneath anger may be found sadness about a loss – may express anger instead because expressing sadness would acknowledge vulnerability 41.
List guidelines for managing emotions è
Empathic responses
help make patients feel cared for & can help stop escalation of emotions è
Become aware of our own blind spots
& hot buttons – we’ll be less prone to being triggered by other people è
Feeling understood
is healing – if we fail to respond, patients may infer that we not care or value their experiences 42.
Describe how to respond mindfully rather than reflexively è
Empathic responses are productive but reflexive responses usually slow rapport & limit healing è
Reflexive reactions tend to be responses designed to guide us away from emotion, because we find strong emotions uncomfortable o
Ex. patient cries & we find it uncomfortable so we reflexively try to “help” them stop crying rather than remain present w/ them in their grief è
Often result in attempts to shut-down emotion or provide premature/false reassurance 43.
List patient behaviours that would be labeled as either active-engaged, active-disengaged or passive coping è
Active-engaged
: o
Problem-focused
= problem solving, planning, positive reinterpretation, seeking support, suppression of competing activities, cognitive restructuring o
Emotion-focused
= social/emotional support, religion, express/vent emotions, humor è
Active-disengaged
(i.e. avoiding): problem avoiding, wishful thinking, restraint coping (waiting for the right time), denial, distraction è
Passive-disengagement: o
Passive emotional
= social withdrawal, behavioural disengagement, self criticism o
Passive illness behaviour
= substances, indulgence, inactivity, aimless activities, mental disengagement 44.
Explain why appropriate communication of bad news is important è
One cannot estimate the impact of the bad news until one has first determined the recipient’s expectations or understanding è
How bad news is presented can affect: o
Patient’s comprehension
of information o
Patient’s satisfaction
w/ medical care
o
Patient’s level of hopefulness
, and subsequent psychological adjustment 45.
List the physician’s responsibilities and ethical/legal implications regarding breaking bad news è
Physicians who find it difficult to give bad news may subject patients to harsh treatments beyond the point where treatment may be expected to be helpful è
Receiving unfavorable medical information does not necessarily cause psychological harm – but can if done improperly è
Must provide patients w/ as much information as they desire about their illness and its treatment – physicians may not withhold medical info even if they suspect it will have a negative effect on the patient è
BUT – disclosing the truth without regard or concern for sensitivity can result in the patients being as upset as if they were lied to 46.
List the steps in the 6-step protocol for delivering bad news & understand what must be asked/communicated (SPIKES procedure) è
Setting up the interview – getting started o
Mental rehearsal before starting & preparing to respond to emotions/questions o
Remember that the bad news is still very important for allowing them to plan for the future o
Create a conducive enviro: give them lots of time, avoid interruptions, private setting, sit close enough to touch their arm if needed o
Have all of the info you need in advance o
Figure out who the patient wants present with them o
Start w/ a question like “how are you feeling right now?” to indicate a 2-way convo è
Perception of the patient – finding out how much the patient knows o
ASK BEFORE YOU TELL o
Use open-ended questions to understand how the patient perceives the situation – “what have you been told about your medical situation so far? What is your understanding of the reasons we did the MRI?” §
Can correct misinformation and tailor the bad news to what the patient understands o
Determine if the patient is engaging in denial: wishful thinking, omission of essential but unfavorable details of the illness, unrealistic expectations è
Invitation – finding out how much the patient wants to know o
Discussing information disclosure w/ the patient, at the time of ordering tests can cue the physician to plan the next discussion with the patient
o
Some patients want to know everything and others do not – if patients don’t want to know details, offer to answer any questions they may have in the future or get the patient’s permission to talk to a relative of friend
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o
Can ask if they are ready to hear everything rn, if they want the basics, or if they’re not ready to hear any of it
o
Be sure to re-evaluate this at the next meeting though – they may change their preferences or want to designate someone to communicate on their behalf
è
Knowledge – sharing the info o
Positive news should be given first o
Give a warning statement – let them know that bad news is coming o
“I am afraid I have some bad news for you”
o
Begin at the patient’s level of comprehension/vocab, use nontechnical words, avoid excessive bluntness, give info in small chunks & check periodically
§
Can ask them to repeat back to you what they would tell their family or how they’d share the info with others
§
Getting them to summarize is a good way to assess their understanding
o
Avoid saying “there is nothing more we can do for you” à
there are going to be more therapeutic goals and pain control, etc. that we can do!!
o
Plan an agenda of topics you want to cover: diagnosis, treatment, prognosis, support/coping o
Use clear, unambiguous language
o
After telling them, pause for a moment to let them digest the information è
Emotions/empathy – responding to the patient’s feelings o
Offer support & solidarity to the patient by making an empathic response §
Observe for any emotion (ex. tearfulness, sadness, silence, shock, anger)
§
Identify the emotion by naming it à
N
URS
§
Identify the reason for the emotion – if you’re unsure, ask the patient §
After giving them time to express their feelings, let them know that you’ve connected the emotion with the reason – using a connecting statement to reflect your understanding of their feelings à
N
U
RS
•
“I know that this isn’t what you wanted to hear”
§
Do not discuss other issues until an emotion has cleared •
Can keep using empathic responses to show support and validate their feelings as legitimate à
NU
R
S
o
Be prepared for outbursts of strong emotion – be able to identify and understand the emotions in order to care for them, but you can also just ask if you’re unsure
§
Affective response = tears, anger, sadness, love, anxiety, relief
§
Cognitive response = denial, blame, guilt, disbelief, fear, loss, shame, intellectualization
§
Psychophysiologic response = fight-flight è
Summary/strategy – planning & follow-through o
Patients who have a clear plan for the future are less likely to feel anxious & uncertain o
Ask patients if they’re ready to make a plan
o
Present treatment options – both a legal mandate
and shows that you care about their goals/wishes
o
Share responsibility for decision-making o
Check for patient misunderstanding o
State plans clearly and set follow-up schedules
47.
Respond appropriately to the question “how long do I have to live?” è
Discuss prognosis/life expectancy without getting stuck on specific numbers/stats è
Tell them that you do not know/you’re not able to give them a timeline, and that every patient is different o
If they keep insisting you can give them a range of months-year, days-weeks, etc. that is broader because this is the closest we can get to the actual time range o
Can use your personal experience with similar patients to try and give them a time frame è
Always communicate hope – address any fears/worries, and discuss improving quality of life 48.
Describe the best way to transition into a sexual history è
develop a routine that avoids judgement & asks for permission, state the context and why it’s important to talk about, signpost and let them know it’s coming è
“I am going to ask a few questions about your sexual health. I understand that these questions are personal, but they’re important for your overall health. Like the rest of our visits, this information is kept in strict confidence if there is no danger posed to yourself or someone else. Do you have any questions before we start?” 49.
Ask the appropriate question from the 6 P’s to a patient of a specific age/sex è
Partners
– never assume sexual orientation è
Practices
– does not necessarily need to be explored if patient has been in a monogamous relationship for the last 12 months; ask about oral, genital, anal è
Protection
from STIs
– explore in non-monogamous relationships or monogamous relationships of less than 12 months è
Past history
of STIs
– have they been diagnosed/tested? Would they like to be tested? o
Patient w/ a current STI/HIV and refuses to protect partners should be more fully explored è
Preventing pregnancy
– should be gender & age appropriate è
Performance – assists diagnosis of sexual dysfunctions 50.
Help a patient to “connect the dots” when discussing prevention of pregnancy
è
If they’re not using protection and still don’t want to get pregnant AND/OR they would keep their baby if they got pregnant and they’re still consuming alcohol and other drugs, causing potential harm to their baby 51.
Determine the causes of sexual problems and sexual dysfunctions è
Higher risk patients: older, certain medications, psychiatric disorders, relationship stressors, stress in their life, sexual trauma/abuse, dissatisfaction, anxiety, chronic health conditions or pain 52.
Describe psycho/social/cultural influence on sexuality è
Psychological impacts almost always accompany a sexual dysfunction/problem o
Stress, depression/anxiety, previous trauma, relationship issues, body image è
Social impacts affect the entire system o
Sexually repressive upbringing, parents’ negative views of sexuality & genitals, sexual myths in media, childhood abuse/incest/rape è
Cultural beliefs play a role in the patient’s response o
Sexual desire conflicts w/ religious, personal, or family values o
Societal taboos about sexuality o
Sexual shaming by certain cultures è
We have been behaviourally and cognitively conditioned to think & act certain ways è
Common physical causes for dysfunction: diabetes, liver disease, pelvic surgery, neurological disorders, fatigue, hormonal changes, medication side effects, alcohol or drug abuse 53.
Discuss concisely the segments & sub-segments of an H&P è
Identifying Data, Chief Complaint, HPI, PMH, FH, PSH è
ROS: general, skin, head, eyes, ears, nose, mouth/throat, breast, respiratory, cardio, GI, urinary, genital, peripheral vascular, musculoskeletal, neuro, hematologic, endocrine, psychiatric 54.
Discuss the importance of the Calgary Cambridge Model in a physician-patient encounter è
Initiating the session, gathering info, physical exam, explanation & planning, closing the session è
Meanwhile providing structure & building rapport è
Goal is to weave together the original content of the traditional history with the added content of the focus on patient perspective è
Supports the patient, builds a relationship, makes consultation more accurate/efficient, improves adherence, addresses symptoms not caused by disease alone, aids in diagnosis, allows a treatment to be negotiated Note: there were no learning objectives on the ROS lecture** Research Findings:
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•
Short sleep duration is linked w/ increased risk of: car accidents, obesity, diabetes, heart problems, depression, substance abuse, headaches, inability to pay attention or remember new information, inability to recover quickly •
~ 38% of adults use CAM à
most Americans use complementary medicine •
1/3 women and ¼ men have experienced one or more: rape, physical violence, stalking by an intimate partner o
Victims report acute trauma & chronic physical/psychological issues resulting in poor overall health o
Domestic violence is the #1 cause of injury to American women •
Health related behaviours account for ~50% of premature morbidity and mortality •
Smoking is the #1 preventable cause of mortality in the US o
Clinician intervention for tobacco use & dependence is one of the most cost-
effective interventions in health care o
Brief advice – even less than 3 minutes – increases quit rates o
A dose-response relationship exists between intensity of treatment & quitting. Treatment that includes both behavioural & pharmacologic interventions is more effective than either element alone. BUT, even brief interventions are effective o
The 3 month cessation rate is 5% without follow up and 15% will follow up à
this is the “arrange” portion of the 5 A’s
•
For every $1 spent on substance use disorder treatment, $4 are saved on healthcare costs •
Smokers die 10 years earlier than nonsmokers •
Excessive alcohol use is the 3
rd
leading lifestyle-related cause of death for the US o
$1.90 in healthcare costs for every alcoholic drink taken •
90% of all adults in the world consume caffeine daily •
The last 1/3 of a cigarette is the most dangerous •
Risk of lung cancers increases w/ the number of cigarettes smoked over time •
In 2013, 9.4% of the population (12 or older) had used an illicit drug in the past month o
Drug use is highest among people in their late teens & twenties o
2.5% had used prescription drugs nonmedically in the past month •
The single screening question “how many times in the past year have you used…?” was 100% sensitive and 74% specific for detecting a current drug disorder & was similar to the use of a 10-item screening tool •
3/10 US adults drink at levels that elevate their risk for physical, mental and social problems •
Only ~10% of patients w/ alcohol use disorders actually received the recommended quality of care •
A primary care physician should assume that at least 1/10 patients sitting in their waiting room has an alcohol use disorder o
9/10 primary care physicians in US fail to correctly diagnose alcohol use disorders CAM
1-
coven
final
o
Brief interventions promote significant, lasting reductions in “at-risk drinkers” •
Some clinicians worry that an incorrect naming
would be off-putting for patients and inhibit relationship building and trust. On the contrary, all people value attempts to comprehend their situation, and usually respond with either grateful appreciation or a more accurate naming of their emotion. This is especially true in healthcare situations. •
By allocating time to discuss sexual health during office visits, high-risk sexual behaviors that can cause sexually transmitted diseases, unintended pregnancies, and unhealthy sexual decisions may be reduced. •
Successful integration of sexual health care into family practice can decrease morbidity and mortality, and enhance well-being and longevity in the patient. •
Unsafe sex, which leads to transmission of human papillomavirus, is responsible for virtually all deaths due to cervical cancer. •
Cervical cancer
is the fourth most frequent cancer
in women with an estimated 570,000 new cases in 2018
representing 6.6% of all female cancers
. •
Approximately 90% of deaths from cervical cancer
occurred in low- and middle-income countries. •
Estimated prevalence of sexual dysfunctions in the general population are as high as: o
52% in males o
63% in females. •
Sexual concerns expressed by females seeking gynecological care are almost universal.