PFC 101

1) Which of the following relationships best reflects the paternalistic model of the patient-provider relationship? a) Parent-child b) Teacher-student c) Commanding officer-soldier d) Hairstylist-client

a) Parent-child

3) Which model of the patient-provider relationship is exhibited when the expert provider simply provides information to patients, who hold decision-making power? a) Paternalistic b) Informative c) Interpretive d) Deliberative

b) Informative

Which of the following is the main reason why minority patients receive lower quality care and less intensive care than white patients in the US? a) Studies show approximately 45% of providers hold overtly racist beliefs and purposefully mistreat minority patients. b) Providers who grow up in societies with negative stereotypes about minority groups may have implicit biases that negatively affect care for those groups. c) Minority patients are actually treated equally in the health care system, but have less access to high quality care. d) Health care providers in the US are mostly white, and white people are susceptible to implicit bias.

b) Providers who grow up in societies with negative stereotypes about minority groups may have implicit biases that negatively affect care for those groups.

Imagine you're a health care provider. A patient presents with a lump in her breast that she first noticed two years ago. When you ask about her medical history, she tells you that she has never seen a health care provider to examine the lump before. What would be the best thing for the provider to do in response to this information? a) Say, "Why did you wait so long to come in? Breast cancer is more curable when it is diagnosed earlier." b) Say, "I'm so glad you came to see me today. Can you help me understand why you weren't able to come in before?" c) The provider shouldn't ask about her delay in seeking care because it's not relevant to the current conversation. d) The provider shouldn't ask about her delay in seeking care because it may come off as judgmental.

b) Say, "I'm so glad you came to see me today. Can you help me understand why you weren't able to come in before?"

3) Which of the following is NOT a step in brief action planning? a) Asking patients if they have any health goals they want to work on in the next week or two b) Telling patients what they need to work on to achieve their health goals c) Asking if patients want to hear ideas about how other people are working on their health goals d) Asking the patients to assess their confidence level in completing their plan

b) Telling patients what they need to work on to achieve their health goals

A pediatric primary care team in California is providing care to a man from Mexico who is living with HIV. The man's wife died of AIDS one year before, and he has a four-year-old son who is HIV-positive as well. Nevertheless, the father hasn't been bringing the child in regularly for care. The pediatrician and her team are growing worried about the child's health, and she suspects that the man may have a different cultural understanding of HIV that makes him less likely to seek medical treatment. Which of the following would be the best action for the pediatrician to take? a) At the man's next visit, the pediatrician should explain the consequences of the boy not receiving care to motivate the father to bring him in. b) The pediatrician should call the father to ask why he's having trouble making the appointments. c) The pediatrician should send a health educator to the home to teach the father about the biological causes of HIV. d) A and B

b) The pediatrician should call the father to ask why he's having trouble making the appointments.

A 24-year-old exchange student from China is in graduate school in London when she develops palpitations, shortness of breath, dizziness, fatigue, and headaches. She visits a primary care team, and following a thorough medical work-up, receives no medical diagnosis. Instead, her primary care provider recommends she start weekly visits with a mental health counselor. She improves a little bit, but the symptoms don't disappear. The mental health counselor refers her to a psychiatrist, who diagnoses her with a depressive-anxiety disorder and prescribes antidepressants. Then, suddenly, the student drops out of care. A social worker visits her at home and learns that she has a cousin with a severe mental disorder, and the stigma around mental illness is so strong in her family that she can't accept that she has a mental health disorder. She says that in China her symptoms are called by another name — neurasthenia or a stress-related condition. What should her health care team do? a) Respect her choice by not trying to contact her. b) The team should contact her again using the term neurasthenia to describe her condition. c) Note in her record that she is non-compliant. d) A and C

b) The team should contact her again using the term neurasthenia to describe her condition.

2) Shared decision making, pioneered by Dr. Victor Montori of the Mayo Clinic, best reflects which of the four models of the patient-provider relationship? a) Paternalistic b) Informative c) Interpretive or deliberative d) None of the above

c) Interpretive or deliberative

A cardiac surgeon is informing a patient and his wife about the risks and benefits of a coronary bypass surgery to treat the man's acute heart disease. The surgeon wants to take a collaborative approach in which the patient ultimately decides about the treatment, with the support of the provider. Which of the following behaviors would undermine such a partnership? a) The surgeon takes a seat when talking to the patient and his wife. b) The surgeon asks, "What matters most to you about your health and your treatment?" c) The surgeon describes the risks and benefits of the surgery, being careful not to share her opinion that the surgery is the best option for long-term heart health. d) The surgeon recognizes the patient's emotion and reflects back the understanding with a comment like, "I understand that you're scared about the surgery."

c) The surgeon describes the risks and benefits of the surgery, being careful not to share her opinion that the surgery is the best option for long-term heart health.

4) Maureen Bisognano, IHI Senior Fellow and President Emerita, has helped popularize the idea of asking patients, "What matters to you?" in addition to, "What's the matter?" This question helps providers do which of the following? a) Make a more accurate diagnosis b) Record their patients' end-of-life care wishes c) Understand patients' health goals and priorities d) Decide on the best treatment option

c) Understand patients' health goals and priorities

6) Which of the following is one of the four components of empathy, as outlined by nurse scholar Theresa Wiseman? a) Judging someone's situation only after talking directly to them b) Helping to solve someone's immediate problem, whether it be physical or emotional c) Understanding another person's feelings in the moment d) Sitting down when speaking with a patient

c) Understanding another person's feelings in the moment

4) Which of the following is a reason why the paternalistic model is unsuitable for improving health outcomes? a) Patients can choose whether or not to follow providers' medical advice. b) Chronic disease is on the rise, and management of chronic disease requires patients to change their behavior. c) Providers have more medical expertise than patients, so their decisions are more likely to promote health. d) A and B

d) A and B

5) You're a hospitalist in a large referral hospital, and you have just discharged a patient who suffered a stroke due to high blood pressure. You've used many strategies, such as Ask-Tell-Ask, shared decision making, and brief action planning with the patient. The patient's primary care doctor says he will follow up with the patient. Two weeks later, the patient is back in the hospital, and you find out the primary care doctor never followed up. What's the best thing to do next? a) Call the primary care doctor to learn more about the miscommunication and how to avoid it in the future. If necessary, conduct a quality improvement project to improve the referral process. b) Avoid referring patients to the primary care doctor in the future. c) Make a note in the patient's record that she was non-compliant in completing the follow-up care plan d) A and B

d) A and B

4) Why do some patients from underserved minority groups sometimes mistrust health care institutions and health care providers? a) Health care providers have betrayed the trust of patients before, such as in the Tuskegee syphilis study. b) Underserved patients often have religious beliefs that teach them that health care providers are untrustworthy. c) Patients may feel that health care systems that are difficult to understand and access do not want to provide them services. d) A and C

d) A and C

5) Why is it important for providers to understand how patients may perceive them, including their race, class, gender, age, and educational status? a) It's important that providers not mistakenly think that social characteristics influence patients' lives but not their own. b) By understanding what assumptions others may make about them, providers may recognize that stereotypes based on social categories may not be accurate. c) Understanding how others perceive them can help providers recognize the need to get to know patients as individuals, rather than only through social characteristics. d) All of the above

d) All of the above

2) A nurse is talking with a patient about the plan for her care after discharge from the hospital. He concludes by saying, "We've just reviewed a lot of information about what happens when you leave the hospital. Did you understand everything OK?" Did he effectively use Teach Back? a) Yes, because he asked the patient to confirm understanding b) No, because he didn't ask the patient to repeat back what she understood c) No, because he placed the responsibility of communication on the patient instead of on himself d) B and C

d) B and C

Which of the following is the description of the term "non-compliance" that best reflects patient-provider partnerships? a) Non-compliance describes patient behavior that doesn't align with the plan of care, for example, not taking medicines as prescribed. b) Non-compliance is a term that comes from the paternalistic model of care, where provider's role is to decide on the plan of care and the patient's role is to follow it. c) When patients don't follow a plan of care, it may be a sign that the health care system is "non-compliant" in meeting patients' needs or goals. d) B and C

d) B and C

5) Imagine you're a first-year resident enjoying a meal at a restaurant on your day off, and another customer starts choking. The customer's companion shouts, "Is there a doctor here?" in a panic. You rush over to assist the patient, who can't breathe. Which of the following patient-provider relationship would be most appropriate in this situation? a) Interpretive b) Deliberative c) Informative d) Paternalistic

d) Paternalistic