Fluid and Macronutrients – clinical consultations

1. Fluid and Macronutrients – clinical consultations • Consultation 1 – Mr Andrew Smith • Consultation 2 – Miss Lisa Evans Focus of the sessions: • Explanation and planning • Specific clinical advice

2. Consultation 1 You are asked to “actively observe” the session and make notes for class “discussion” on…… • How the clinician explains the situation and achieves shared decision making in planning care. • The specific advice the Dr gives.

3. Consultation 1 • Explanation and planning

4. Specific advice

5. A recap – explanation and planning • Providing the correct amount and type of information • Chunks and checks • Assessing patients starting point • Gives explanation at appropriate time

6. Aiding recall Uses repetition and summarising

7. Achieving a shared understanding • Provides opportunities and encourages patient to contribute • Elicits patient’s beliefs, reactions and feelings

8. Planning and shared decision making • Shares own thinking – as appropriate • Negotiates a mutually acceptable plan • Offers choices

9. Top tip for the end of the consult “Is there anything else you would like to ask or say?”

10. Consultation 2 • Lisa Evans – Renal failure (proteins) • Ms Evans is a 28 year old administrator. • She is a single parent – with a five year old son. • Setting: • She is attending an appointment at the G.P.s following on from a recent first appointment at the local renal outpatient clinic – she has stage 5 renal failure. • She was given a lot of information at her visit and has come in to discuss the dietary aspects of this advice. • Patients perspective: • You are anxious following your visit to the renal outpatients – as you can’t remember a lot of what was said, as they seemed to speak in lots of jargon– but you do remember them telling you not to eat high protein foods. You know these foods are important for your sons growth. • PMH: • Asthma • Family history: • High Blood pressure • Mother stroke in late 50’s • Both parents alive

11. Patients perspective: • You are anxious following your visit to the renal outpatients – as you can’t remember a lot of what was said, as they seemed to speak in lots of jargon– but you do remember them telling you not to eat high protein foods. You know these foods are important for your sons growth. • The Dr there also mentioned Sodium and Potassium in food and restricting the amount of fluid you drink every day. You can’t get past the thought of Kidney failure! • PMH: • Asthma • Family history: • High Blood pressure • Mother stroke in late 50’s • Both parents alive

12. Thank you – for your attention! Please keep your eyes on the module site this week for further instructions!