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Approaching a patient & their problem: what guides your practice?

Prescribing for pain: E thical considerations that should guide clinical practice Associate Professor Mark Boughey , St Vincent’s Melbourne. Approaching a patient & their problem: what guides your practice?. Today’s aim

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Approaching a patient & their problem: what guides your practice?

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  1. Prescribing for pain: Ethical considerations that should guide clinical practice Associate Professor Mark Boughey, St Vincent’s Melbourne

  2. Approaching a patient & their problem: what guides your practice?

  3. Today’s aim • Demonstrate how you can frame practice and decision making within a clinical ethical basis • Think about the elements that come into play – make you conscious of what you may already be doing • Use pain prescribing as an exemplar

  4. Why pain: • Complex medical problem • Complex interplay between peripheral & central NS • Complex interplay between nociceptive, neuropathic and psychological/existential • Dealing with a variety of distinct pain entities-acute, chronic, progressive/palliative • Treatment modalities are multiple and come with risk/benefits that vary depending on what you are treating

  5. Approaching a patient & their problem: what guides your practice? Practice ? Theory Knowledge Action reflection Tools & algorithms Gut feeling

  6. Approaching a patient & their problem: what guides your practice? Practice ? Theory Ethical guidance Knowledge Action reflection Tools & algorithms Gut feeling

  7. My general approach to ethical considerations…… Patient views History Expectations Issues What does the patient want? Autonomy Evidence Guidance docs Consensus of opinion Experience Knowledge What is going to help? What might hinder or harm? Beneficence Non Maleficence Legal/illegal Scope of practice System supports Availability Who gets what? Justice

  8. My approach to ethical considerations when prescribing for pain …… What does the patient want? Autonomy What is going to help? What might hinder or harm? Beneficence Non Maleficence Who gets what? Justice

  9. My approach to ethical considerations when prescribing for pain …… Patient views History Expectations Issues What does the patient want? Autonomy What is going to help? What might hinder or harm? Beneficence Non Maleficence Who gets what? Justice

  10. My approach to ethical considerations when prescribing for pain …… Evidence Guidance docs Consensus of opinion Experience Knowledge What does the patient want? Autonomy What is going to help? What might hinder or harm? Beneficence Non Maleficence Who gets what? Justice

  11. My approach to ethical considerations when prescribing for pain …… Legal/illegal Scope of practice System supports Availability What does the patient want? Autonomy What is going to help? What might hinder or harm? Beneficence Non Maleficence Who gets what? Justice

  12. What does it all mean?

  13. Practice Theory Knowledge Patient wants /needs What helps What harms Who gets what Tools & algorithms Opioids Non opioids Physical Psycho/spiritual Gut feeling

  14. Context • Competence Creativity New ways to solve new problems Flexibility How to cope when things go wrong Knowing when to do what Basic skills

  15. Prescribing for pain: Ethical considerations that should guide clinical practice Associate Professor Mark Boughey, St Vincent’s Melbourne

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