AETCOM Community Medicine (PSM) For 3rd year MBBS CBME

Hello everyone and welcome to Quick Med 101. I am Pratamai Joshi and today we are going to talk about 8 Com for PSM. In this episode we will be covering the questions related to PSM which will be asked in the University exams for the 7 mark questions. So here we have module 3.1 and 3.3. So the 3.1 module is the foundations of communication part 3 which will be demonstrating the ability to communicate to the patients in a patient respectful, non-threatening, non-judgmental and empathetic manner and module 3.3 is the foundation of communication part 4 of which the third part is RSNPSM which is administer informed consent and appropriately at the patient queries to a patient undergoing a surgical procedure in a simulated environment. Now we are going to see a case. A 6 year old boy is brought to the emergency department with a single episode of Toniclinic Seager. Child is stabilized with IV antireplectic and oral antireplectic is started. When further investigation and treatment is suggested, parents asked, parents said, "Thank your doctor for helping us now in this time of need but we feel it is against our faith to continue allopathic care. The convulsion is a result of curse to our ancestors and we urge you to stop the treatment and we want to discharge from the hospital right now." Describe role of a doctor as a healer in this case. Second, identify and discuss different medical, legal, socio-cultural and analytical issues as they deny the further treatment. So the answer to this question will be, "The role of a doctor as a healer is to use his or her medical knowledge, skills and experience to diagnose and treat the child's medical condition and to promote and protect the child's health related interest and will be. The doctor also has a duty to respect the parents' beliefs and preferences and to communicate with them in a respectful and empathetic manner. The doctor should try to understand the parent's perspective and concerns, explain the diagnosis, prognosis and treatment options in a clear and simple way. The doctor should also educate the parents about the benefits and risk of the treatment and the potential consequences of the not treating the child. The doctor should negotiate with the parents and try to find a common ground or a compromise and involve the child in the decision making process of appropriate. The doctor should seek advice from the colleagues, supervisors or ethics committee of the parents persistent refusing the treatment and the child's condition is serious or life-threatening. The doctor should consider a legal or protective measure as a last resort and only after exhausting all other options. This issue involved in the case are medical legal. The parents have the legal right and responsibility to make a medical decision for their child, as long as they act in the child's best interest. However, this right is not absolute and can be overwritten by the state if the child's life or health is in the danger. The doctor has the legal obligation to report the case to the authorities if he or she believes that the child is at risk or harmonically. The doctor also has the legal option to seek a court order to authorize the treatment of the parents' refusal to consent. The doctor should be aware of the relevant laws and policies in his or her jurisdiction and the document the case carefully. Social cultural. The parents' refusal of the treatment may be based on their religious, cultural or ethical beliefs and the values which may differ from those of the doctor and the mainstream society. The doctor should respect the parents' belief and the value and avoid imposing his or her own views on them. The doctor should also acknowledge the diversity and complexity of the parents' beliefs and values and avoid stereotyping or judging them. The doctor should use a translator or a cultural mediator if needed and seek to understand the parents' worldview and the meaning they attach to the child's ill-nacing treatment. The doctor should also explore the possibility of integrating parents' preferred healing methods with the alipetit care as long as they are not harmful or incompatible. Ethical. The parents' refusal of the treatment poses an ethical dilemma for the doctor who has to balance respect for the parents' autonomy and recognition of the parent child relationship as an important childhood interest against the obligation to act in the best interest of the child and to prevent harm. The doctor should apply the ethical principles and frameworks that are relevant to this case, such as harm constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. The doctor should also consider the child's age and maturity, parents' reason for refusal and legal and ethical implications of overriding their decision. This question which can be asked in this module is right about the doctor-patient relationship and we already know how to write that question very well and we have already covered that in the second year of podcast but I will still be covering that in very brief manner. The attitude of the doctor towards the patient is the first step which will zirapow between the two. When the patient is in pain and suffering, identify the condition properly, treat and console him rather than treating them like a customer. This should be benevolent towards the patient that is gentle while receiving the patient and then examining the patient. He should have sympathy and understanding towards the patient and does not mean that he should shed tears but be kind-hearted, gracious, considerate and compassionate. The doctor should be good in communication, competency and the continued learning, nitty and diversity. India is a country of multiple languages and many cultures. Diversity is our strength and the doctor should be sensitive to these cultural differences while treating the patient. With respect to their culture, appreciate rather than discourage or argue. A deed should not have any deteriorous effect on the body or mind. Evidence-based practice and ethics. Every doctor should appreciate the need for update and familiar with the different therapeutic modalities. Administration of the essential drugs in their common side effects. Some points to keep in mind are we must know and accept our limitations. Referee patients on time and not late communicate with the patients and their families effectively. Do what is required for the patient at the moment without commenting on the past or commenting on other treatment. Do not negate patients' views even after you convince effectively. Don't react impulsively and adversely. Be patient with your patients. Do your job to satisfy your conscience. Be united in critical times. Keep yourself updated about the subject. Now we have a question pertaining to at commodule 3.1. The student should be able to communicate to the patients in a respectful, non-threatening and non-judgmental and empathetic manner. The answer should be, the communication is a fundamental prerequisite of the medical profession and besides skills, it is crucial in ensuring professional success for the doctors. The Kalamazoo consensus statement provides a normal working model for teaching communications skills and may be used to impart them. This model identifies a set of seven essential communication elements as stated below. Build the doctor-patient relationship. Strong therapeutic and effective relationship is the need of the physician-patient communication. A patient-centered approach to core emphasizes on the patient's disease and her illness experience. The physician must elicit the patient's story of illness while guarding the interview through a process of diagnostic reasoning. Both the physician and the patient must be aware that the ideas, feelings and values of both the parties equally influence the relationship. This approach regards the physician-patient relationship as a partnership where the patient's active participation in the decision making is respected and required. Second, the open discussion. The physician must allow the patient to complete his or her opening statement, elicit the patient's full set of concerns, establish or maintain a personal connection, gather information. The physician uses open-ended and closed-ended questions appropriately and he or she must structure, clarify and summarize the information. The physician must also actively listen using non-verbal, that is eye contact and verbal, that is words of encouragement techniques. Understand the patient's perspective is the fourth technique. The doctor should explore the various contextual factors like family, culture, gender, age, social, status, spirituality, beliefs, concerns and expectations about health and illness. Acknowledge and respond to the patient's ideas, feelings and values. Fifth is share the information. Use the language the patient can understand, avoid medical joggings, check for understanding and encourage patients from the patient. Sixth is reach agreement on problems and plans. Encourage the patient to participate in decisions to the extent that he or she desires. Check the patient's willingness and ability to follow the plan, identify and enlist resources and the support. Seventh is provide closure. As the patient whether he or she has any other concerns, summarize and affirm the agreement with the plan of action. Discuss the follow that is next visit plan for unexpected outcomes etc. This outline of the essential elements of communication provides a coherent framework for teaching and reassuring the skills. Determining relevant knowledge and attitudes regarding the educational programs. Incurs a collaboration and consensus of individuals with a variety of background and interests in medical education. Aim to increase the efficiency and efficacy of physician patient communication, enhances patients and physician satisfaction and helps to improve health outcome. Next we have is foundations of communication, module 3.3. The student should be able to administer informed consent and appropriately address patient queries to patient undergoing surgical procedure in a simulator environment. The answer to this should be consent connotes agreement compliance or permission given voluntarily without compulsion. This concept comes from ethical issues of the respect for individual integrity as well as self-diptermination. Each individual has the right to do what he or she likes with his or her body to preserve and protect one's health and personal privacy. The process for getting permission of the patient before conducting a medical intervention on him or her or before conducting some form of research involving an exchange of information between the doctor and the competent individual as regarded as the informed consent. It is a medical legal term describing the conversation between the patient and the physician [BLANK_AUDIO] The physician provides all relevant and necessary information for a patient to make informed free and sound decisions regarding his or her will. Inform concept fits firmly with the foundation of ethical medical practice that is autonomy, beneficence, non-melfacence and justice. The three basic components of the informed consent that is competency disclosure and voluntaryness were expanded to four elements by the Concord in 2013. There is description of the clinical problem, proposed treatment and the alternative, including no treatment. Discussion of the risk and benefit of the proposed treatment with components of the risk and benefit of alternative and the discussion of medical and clinical uncertainties regarding the proposed treatment. Assessment of the patient's understanding of the information provided by the medical provider, solicitation of the patient, preference and consent for the treatment. It is important that the patient arrives at a decision without being subjected to coercion, induce, influence and inducement or inhibition or intimidation. An informed consent incorporates the ethical and legal obligation of the medical professionals to ensure that the patient is competent, that is they have the ability to understand the information relevant to making the decision and to appreciate the reasonably foreseeable consequences of the decision or lack thereof. The patient comprehends the information provided including explanations and disclosures of the intended intervention. On-risk and complication benefit available alternatives. It represents a collaborative decision making between the physician and the patient regarding the steps that will be followed in the core. It is formally obtained as written documents signed by the patient and the physician in the presence of the witness. However, now with the advances in the technology, digital dynamic consent are administered in the Western countries as they cause less errors and can be indexed and stored. It can be done at leisure and can also be changed or edited at times changes. In general, a blanket consent form should never be used. Special consent forms for each procedure should be taken with a clear explanation of all options, medical and surgical and alternative remedies. The nature of the procedure and intervention, risk and benefit of the procedure and the alternative, percentage of the success in failure, total number of days and hospital stays, total cost of the treatment, major complication and the assessment of the patient's understanding. The teach back technique where the physician asks the patient or the prospective participant to discuss the proposed treatment in own words is recommended as it helps to gauge the comprehension and identify gaps in the patient's understanding. Verbal consent must also be documented in the medical treatment, even though the legally written consent takes precedence. A full disclosure affects the patient emotionally, informed full details to one of the close relatives in full confidentiality. This is called a therapeutic privilege, which is the exception for the rule of full disclosure. No guarantee of cure should be given, also informed the patient that his right to refuse or allow the patient to take decision unwillingly without the food. So that was all for the 8.0 PSM. Thank you so much for listening to this podcast and please subscribe to QuikMed 101 on whichever platform you're listening to. Please press the bell icon that is you will be notified about whenever the new episode will be coming. Also please give your feedbacks in the Q&A section of Spotify's page of this podcast. Thank you so much for listening to QuikMed 101 podcast. Share with your friends and best luck for your exams. Goodbye.