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Consultations & Preparations…

Consultations & Preparations…. Alya Reeve, MD, MPH Continuum of Care DDMI-TUG 4-9-2012. Objectives. Review expectations for case consultations: Medical, Therapy, Family, Spiritual Other… Hear & discuss cases we are encountering in the present. What Is Our Question?.

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Consultations & Preparations…

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  1. Consultations & Preparations… Alya Reeve, MD, MPH Continuum of Care DDMI-TUG 4-9-2012

  2. Objectives • Review expectations for case consultations: • Medical, • Therapy, • Family, • Spiritual • Other… • Hear & discuss cases we are encountering in the present.

  3. What Is Our Question? • Clarify the purpose of consultation • Solve a specific problem? • Get an integrated overview? • Help resolve external struggles (team, guardian, specialists, etc.) • Think of important context for presenting a person, at this point in their life. • Age – what are their tasks of living? • What are their physical capabilities? • What are their mental capabilities?

  4. Purpose of Individual Context • BIOlogical – PSYCHOlogical – SOCial • All the conditions of our organism • How has our personality developed? E.g.: • Reactive or observer; expressive; movement oriented? • Flexible? controlling? Passive? Avoidant?... • What are our connections with other people? • Do we have close friends? • To whom do we turn in times of stress?

  5. Formulating A Story • Establish a story (it is made to fit to the time available) • Who • What • When • Where • Provide a timeline (accuracy is important) • Relative to the individual’s lifetime ~ • when did the current situation begin, • how much has it affected their QOL/daily living

  6. Furthering the Story • Give room for new information and hypotheses • Use clarifying questions • Understand purpose of further information (laboratory tests, treatments, interventions) • Purpose: to build to future experience • Prevention of illness • Resolution of problem • New skills and adaptive behavior…

  7. Medical Consultations • One sentence biological descriptor: age, gender, social relationship, position. • Two sentence problem: the issue, timeline; factors tried to address it; results to date. • Current physical state: vital signs; pain. • Past History: all past medical conditions and treatments; active and dormant; development. • Medications: all medications, supplements, and ongoing therapies. • Living situation: housing situation, guardianship, pharmacy, work, leisure, relationships and community activities.

  8. Shall We Discuss Some Cases?

  9. Synergy of ideas & information…

  10. Conclusion • Presentation preparation helps to improve the quality and usefulness of consultations (most of the time). • Communicating results of interactions with consultants • Updating changes since last consultation • Don’t assume continuous historical knowledge • Highlight benefits and bad results (specifics) We are always seeking to improve; there is no perfect.

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