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Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Practicing proper etiquette through patient engagement, comfort, and clear communication is crucial while performing a physical exam. A pleasant encounter will allow the clinician to build rapport with the patient, positively impact patient satisfaction, and gain more accurate information. Prior to beginning the exam, introduce yourself and warmly greet the patient with a smile and shake the patient’s hand, if feasible. Address the patient by name and make eye contact throughout the encounter. Explain the purpose of the exam and ask the patient for permission to proceed. Listen with empathy while taking note of the patient’s non-verbal expressions. If the patient shows signs of pain or discomfort during the exam, stop and address the immediate concern and delay the exam until the patient is ready to continue.
Cultural Factors Enriching Palliative Care in the Middle East
Published in Kathleen Benton, Renzo Pegoraro, Finding Dignity at the End of Life, 2020
Azar Naveen Saleem, Azza Adel Hassan
Unlike in Western society, free interaction between the opposite sexes is discouraged. Usually, healthy gender segregation is the norm once children reach the age of adolescence. In Islam, any relationship with the opposite gender should be purposeful. The institution of marriage is highly respected, forms the basis of society, and is the only acceptable relationship between an unrelated man and woman. Even 1400 years ago, as the scriptures suggest, Muslim women held their dignity and were usually shy around men; however, they were confident enough to work and address men when necessary. The Quran and the teachings of Prophet Mohammed (PBUH) have highly emphasized respecting and protecting women. The etiquette and rules of gender interaction extend to all fields, which also includes healthcare.
Approach to the patient in primary care psychiatry
Published in Laeth Sari Nasir, Arwa K Abdul-Haq, Caring for Arab Patients, 2018
Laeth S Nasir, Arwa K Abdul-Haq
Not infrequently, patients and families are in denial regarding the nature of the illness. Often, a psychiatric explanation will be rejected, partly because of the perceived stigma and potential damage to the patient’s or the family’s reputation. The provider must be very alert to this response; etiquette will often prevent the patient or family from openly expressing disagreement with the physician’s views. Instead, the patient may not comply with treatment, or will seek care elsewhere. One way to assess the degree of understanding and acceptance is to encourage the patient, at or near the end of the visit, to summarize his or her understanding of the diagnosis or treatment. Sometimes, acceptance of the diagnosis by key family members may be as important as, or more important than, getting the patient to accept the diagnosis. In these cases, having a close working knowledge and relationship with the family is critical. In most cases, it is important to involve family members in order to provide support, reassurance and education.23
Ethical Issues in Using Behavior Contracts to Manage the “Difficult” Patient and Family
Published in The American Journal of Bioethics, 2023
Imposing a demand of decorum on patients and families trivializes the emotional state individuals are in when they themselves are ill or when witnessing illness in someone they care about. Feelings of despair, hopelessness, agony, loss, fear, uncertainty, and anxiety run rampant in the healthcare context. Against this backdrop, behavior contracts set an unfair standard of behavior for people facing tremendous stressors and extreme emotions. Patients and families constitute an emotionally vulnerable population, a population which cannot be expected to be on their best behavior. A serious health crisis is not the occasion for finery or one’s best manners. It is commendable when people in crisis demonstrate good manners and courteous behavior, but they are unreasonable as an expectation or criteria for treatment. While healthcare providers can certainly demand not to be physically hurt or assaulted, they cannot expect their clientele to be calm, to manage grief and frustration with the highest levels of maturity and psychological control, or to display good etiquette. Behavior contracts impose an unreasonable standard of conduct on individuals in crisis.
Observation tool to measure patient-centered behaviors on rounds in an academic medical center
Published in Medical Education Online, 2022
Michelle Sharp, Nicole Williams, Sean Tackett, Laura A. Hanyok, Colleen Christmas, Cynthia S. Rand, Roy C. Ziegelstein, Janet D. Record
Etiquette-based medicine, which has been defined as treating the patient courteously [22] and having respect for the patient’s space and perspective, has been increasingly recognized as important to patients [26–28]. Teams knocked upon entering the patient’s room 78.6% of the time on the PCC team vs. 38.4% of the time on other teams. The latter frequency is similar to that found by Tackett et al. in which knocking occurred 40% of the time among hospitalists [9]. Teams asked permission before beginning the examination around 65% of the time, which was more frequently than observed in Real et al. [23]. Our PCC curriculum prioritizes teaching trainees to seek to understand each patient as an individual and to focus on the humanity and autonomy of each patient. Knocking on a patient’s door, asking permission before adjusting lighting or objects in the patient’s room, and asking permission before beginning the examination on rounds are examples of specific behaviors that can convey respect for a patient’s autonomy and humanity. While many of our faculty are familiar with the concept of etiquette-based medicine, no specific guidance on implementing etiquette-based rounding exists within our curriculum. Our results suggest that participation in the PCC curriculum might be associated with teams considering the patient’s space and perspective more often during rounds. However, if the goal is more frequent etiquette-based behaviors during rounds, more explicit teaching of etiquette-based behaviors may be necessary.
Antibiotic deprescribing: Spanish general practitioners’ views on a new strategy to reduce inappropriate use of antibiotics in primary care
Published in European Journal of General Practice, 2022
Carl Llor, Gloria Cordoba, Sandi Michele de Oliveira, Lars Bjerrum, Ana Moragas
Another factor to highlight is that many GPs do not wish to contradict the decision made by other doctors because it might be viewed as unfair [22]. This phenomenon, referred to as ‘prescribing etiquette’, is a crucial determinant of behaviour, with prescribing decisions influenced not only by clinical goals but also by cultural determinants [23]. In our study, only half of the GPs agreed to deprescribe when a colleague initiated the antibiotic, mainly because they do not wish to offend a colleague who decided to start an antibiotic course. In this study, senior doctors tend to set aside the so-called ‘prescribing etiquette’. This might indicate that hierarchy and experience mitigate the influence of this etiquette. Doctors working at emergency departments who might have prescribed an unnecessary antibiotic tend to be younger – many trainees and junior doctors are hired in this setting, and this could explain why senior doctors are more confident in stopping unnecessary antibiotic treatments than their younger counterparts.