ICEandRAPRIOP

Family Medicine: essential consultation skills全科医学：重点诊症技巧,五大重点,米饭假设推断模式PROMPTRAPRIOP内心问诊,ReasonsIdeasConcernsExpectations,6,你觉得这是甚麽病,你担心这是甚麽病,你期望我可以怎样帮到你,RICE 有什么好?,减省时间强化沟通提升病人滿意度,测试假设,病人提示,现有提示,制定假设,假设推断模式,测试假设,病人提示,现有提示,制定假设,假设推断模式,诊断技巧: PROMPT,Probability diagnosis 机率诊断Red flags 红旗O the Often missed 时常错过诊断Masquerades 伪装Patient wants toTell you something病人还有事情想告诉你,Strategy 1: 机率诊断,Spot diagnosesPattern recognition,Strategy 1: 机率诊断,Spot diagnosesPattern recognition,Strategy 2: 红旗,每个症状都有相关高危病征,Strategy 3: 时常错过诊断,高危病：不可遗漏癌症传染病 (HIV, meningitis, sepsis, infective endocarditis, pneumonia哮喘冠心病自杀諗头或计划宫外孕,Strategy 3: 时常错过诊断,容易忽略药物反应过敏外来物件环境因素大便阻塞导致的腹泻带状疱疹血色沉着病导致疲劳营养不良更年期早期怀孕,Strategy 4: 伪装病,抑郁症糖尿病贫血内分泌失调尿道炎帕金森氏病,Strategies 5: hidden agenda,甚么时候要考虑？病征含糊病征持续太长时间,有了正確診斷之後新診斷糖尿病流行性感冒膝盖关节炎,Management: RAPRIOP,Reassurance & explanationAdvicePrescriptionReferralInvestigationObservePrevention,Inner Consultation内心问诊,Connecting 联繫Summarizing 总结Hand Over 移交Safety Netting 安全网House Keeping 自我保養,20,Connecting 联繫,establish an effective workingrelationship with patient与患者建立有效的关系obtain information 获取病歷develop empathy 同理心See world through patients eyes思病人所思Feel how they are feeling 想病人所想Tell how they think from the words that they use讲病人所讲,21,Summarizing 总结,Gather information总结信息Checking with patient跟病人覆核資料Helps make diagnosis初步诊断Practical test of understanding证实自己是否已经了解情况Care plan formulation制定计划,22,Handover 移交,Returning responsibility to the patient 将责任交给病人Involves:Explanation解释Negotiation协商Collaboration 合作Influence感化Thinking aloud 将思想告诉病人Gift wrapping 包裝 (甜言蜜语)Point at which patient feels well equipped to depart 知道患者已经准备离开,23,Patient always go first 让病人先讲,Special Techniques,24,Explain why you are askingGift wrapping,Patient is always right (initially) 患者总是对的,Safety-Netting 安全网,What ifs制定一个和与患者相关的应急方案确定计划是可行确保患者在任何情况下都是安全患者会有安全感，并感谢你为他考虑得那么周全（病人也可能会想到很多以后的问题）,25,House Keeping自我保養,Taking care of yourself 照顾自己Clearing your mind