1 / 6

TEACH 2013 Track 1

TEACH 2013 Track 1. Problem Delineation. CASE. 63 year old Jewish female brought to ED by family for sudden onset palpitations. Daughter states this has happened before, medications did not work, and patient needed to be “shocked”. PMH: HTN; no structural heart disease

zudora
Download Presentation

TEACH 2013 Track 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TEACH 2013Track 1 Problem Delineation

  2. CASE • 63 year old Jewish female brought to ED by family for sudden onset palpitations. • Daughter states this has happened before, medications did not work, and patient needed to be “shocked”. • PMH: HTN; no structural heart disease • Afebrile, HR 140-160, BP stable, RR 15, SpO2 97% RA • Normal mental status • Tachycardic, irregularly irregular • Lungs clear, no JVD • No peripheral edema

  3. CASE • Patient and family want her to be electrically cardioverted and discharged from the ER in order to attend grandson’s Bar Mitsvah.

  4. Perspectives “I don’t want to miss the Bar Mitsvah. Medications seem to be a waste of time. Shock me so I can go home.” “Hospital practice is to admit. Do I prioritize rate or rhythm control? Which drug should I use?” “Why can’t we just do what the family wants?”

  5. What’s happening? • The patient, her family, medical and nursing staff have different understandings of the problem. • Under time pressures, clinical approaches may not always reflect due consideration of the different perspectives. • When this happens, information skills may serve to inform care decisions that fail to adequately address patient’s concerns and interests • The PACT tool is a vehicle for systematically considering different perspectives in the course of delineating a clinical problem.

  6. PACT • Define the following perspectives at play: • Patient perspectives • Practitioner perspectives • Within these perspectives, consider how much emphasis is on issues of: • Therpy • Diagnosis • Prognosis • Harm

More Related