1. DR/KHALID AL-HARBY MANAGEMENT & MEDICOLEGAL ISSUES DR/ KHALID DHAIFULLAH AL-HARBY MBBS,ABFM,SBFM

2. DR/KHALID AL-HARBY Patient management(CRAPRIOP) C: Clarification R: Reassurance (should be appropriate) A: Advice, counseling ( must be realistic , individualized) P: Prescription R: Referral (or consultation) I: Investigation O: Observation P: Prevention

4. Curative (e.g gamma benzene hexachloride lotion for scabies)

6. As a trial of treatment (e.g a course of Na cromoglycate if ? Exercise-induced asthma

7. To relieve doctor’s anxiety when uncertain of diagnosis c) both

8. DR/KHALID AL-HARBY What evidence is there that the natural history of this problem will be helped by any medication? e.g. antibiotics for URTIs What evidence is available regarding: comparative effectiveness (24 different NSAIDs in BNF), hazards, costs? CI, interactions, optimal dosage and duration? What are the factors that affects patient’s compliance? Is there a need for supervision?

9. DR/KHALID AL-HARBY The doctor-patient relationship Has 3 elements: therapeutic alliance transference counter transference Causes of wrong relationships: Assumptions Detachment Anxiety 4) Difficult patient 5) Frequent attendance 6) Dependence

10. DR/KHALID AL-HARBY The doctor-patient relationship Seating strategies: co-operation, confrontation, conversation

11. DR/KHALID AL-HARBY Types of questions: Open (tell me how it affects you?) Probing ( what aggravates the pain?) Prompts ( you say the pain comes on when you move. Can you describe more precisely what movements brings it on?) Closed (have you lost weight?) Leading (would you agree that this pain could be due to anxiety?) Double-barrelled ( have you tried taking paracetamol…or an antacid for your pain?)

12. DR/KHALID AL-HARBY Anticipatory care Prevention + Health promotion (encourages people to achieve the best possible level) Preliminary prevention Primary prevention (H.E., prophylaxis) Secondary prevention (screening, case finding) Tertiary prevention Opportunistic health promotion

13. DR/KHALID AL-HARBY Ethics in practice Fundamental ethical principles in health care: Justice ( or equity) Beneficence ( and non-maleficence) Respect for persons

14. DR/KHALID AL-HARBY Respect for persons Respect for patient autonomy (can be reduced but never absence; people must be allowed to control their health) Informed consent Truth-telling Respect for confidentiality

15. DR/KHALID AL-HARBY Ethics v.s Medico legality A gift given to you by a rich man or drug representative!!! How to deal with it? Young man with STD (not to tell the wife!!) Colleague's mistake written in the file! Giving diagnosis for a relative on the telephone! Annual appraisal of colleagues (implications on all) How is your supervisor?