Clinician Conundrum

Note: Patients will tell you what you want to hear, so be careful how you ask your questions.

The key steps involved in evidence based practice come from a thirst for knowledge that once ignited makes the next step to asking a well worded clinical question easier. A well formulated question improves patient outcomes and supports the implementation of change. One such method looks at foreground and background questions. A background question is usually a basic knowledge question and is usually answered by a textbook. Foreground questions are usually specific and once answered can help in clinical changes. An acronym useful for formulating a well worded question is PICOT. ( Stillwell, Fineout-Overholt, Melnyk, Williamson, 2010).

2. What additional questions should you ask regarding this patient’s chief reason for seeking care?

The development of focused clinical questions begins with the identification of the patient, population, or problem. This component of PICO must be carefully defined to avoid information that is too general or off topic (Adams, 2012). For example, there is a difference between the adult population and the elderly population. This distinction must be made in this component of PICO to yield accurate search results. The intervention of interest should also be specified to produce applicable information (Adams, 2012). According to Adams (2012), the

The 25 participants were interviewed by a certified doctor and were asked questions regarding their

Investigate and clarify how the patient meets criteria for the disorder(s) as per the patient 's side effects and the criteria sketched out in the symptomatic manual.

If a patient makes an enquiry and you are unsure of it is better to seek the correct information from a colleague than to give the wrong information.

Form a clinical question using PICO format for a therapy / intervention, diagnosis, harm, prognosis, meaning, or human response clinical problem

On pages 234-235 is the format to use for interviewing doctors and the questions to ask.

Patients must be provided with adequate information for them to make an informed decision. The clinician must explain.

A clinical question needs to be precisely significant to the patient or problem at hand and expressed in such a way as to aid in the search for an answer. PICO makes this process easier. It is a memory aid for the vital parts of a well-built clinical question. It also helps formulate the search approach

Ask open-ended questions: In order to get enough information about the patient’s diagnosis, it’s advisable to ask the open-ended questions. This is because Chinese are believed to communicate indirectly and rarely say no. Thus, open-ended questions are the best way of collecting information.

Hugo was born in 2005 and 18 months later was diagnosed with severe Haemophilia A. The mother, Danielle, and the family were shocked by this news as recent family history showed no previous incidents of Haemophilia. Danielle was tested and found to be a carrier of Haemophilia due to a deletion mutation on her factor VIII gene. Danielle and her partner wanted more children but faced a dilemma. If they another child, it could have severe Haemophilia. She doesn’t want Hugo to feel discouraged or aberrant and is in a current situation as to which route to take. She can either side with the use of IVF and PGD, or conceive naturally and take the risk.

If staff members were fighting near a patient on the unit I would personally intervene and confront the situation. I would tell both of the staff members that I would like to speak with them. Once we were all are in a private area I would tell the staff members that if they have an issue with one another that they need to work it out privately and not in front of our patients. State that this is very unprofessional and that it should never occur. If I ever saw the staff members fighting again I would then take the issue to my charge nurse to let him or her know what was happening.

What the patient and the physician really want to know in this context is the