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Facing Our Failures. Rothenberger and Howard M. Baxter 39 Medicolegal and Ethical Dilemmas. Keune and Ira J. Senagore 41 Defining Competence and the Role of the Board.

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Schoetz Jr. Thorson Index. Billingham, M. Smith and Anjali S. Know the answers beforehand in order to ease the encounter. This chapter may seem unusual for a textbook of surgery. How does one create an atmosphere of trust with patients? As with all human interactions, first impressions are key, and this chapter is a subjective look at the topic from the perspective of two surgeons at opposite ends of their careers.

The topic is quite subjective, so we draw heavily from our experiences in order to provide the perspective of both a senior surgeon with 40 years of experience in the field of colon and rectal surgery LE Smith and that of a junior surgeon just starting her colorectal surgery specialty prostate volume calculator mskcc AS Kumar.

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We preface our individual statements with our respective voices. LE Smith In writing this chapter, I reflect on more than 40 years of seeing patients in military, academic, and nonprofit private hospitals.

The patients prostate volume calculator mskcc each type of hospital vary to some degree, but certain universal principles exist to help enlist the patient as an ally in solving his or her problem. One principle that has guided me throughout life is worth sharing, because it applies to surgery as it does to life. As a child in grammar school, I was given a cheap in.

It has served me well in my surgical career. AS Kumar In working with Dr. Smith to prostate volume calculator prostate volume calculator mskcc this chapter, I reflect on my first 3 years building a practice and a referral base within our region.

I was hired to help Dr. Smith retire, but soon found that his referral network consisted of physicians of his generation who thought an older, more experienced physician would be better suited to care for their patients than someone who was just starting out of fellowship.

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Steele et al. Once securing an appointment with a new patient, it is prostate volume calculator mskcc that I give the best of care, be well liked and well respected by my patients, no matter what the circumstances. I quickly found that patients would refer their friends and families to me if they saw me as a passionate advocate for their health. Keep in mind that someday roles may reverse, and you could be the patient.

In the first encounter and the succeeding ones, imagine yourself on the receiving end of whatever it is that you are dispensing—an unfavorable pathologic result, the terminal sentence of a chronic disease, the news of a permanent, potentially disfiguring procedure that offers the best chance for a cure, or even a lubricated finger.

Make it as easy as possible within reason for your patients and your referring physicians to gain access to you, whether it is through the phone, e-mail, or in person. The team—every member of it—must be competent and convey this sense to the patient. The selection of your patientoriented team is, therefore, critical.

Regardless of how thoughtful, competent, well-trained, and skilled you are, the patient will ultimately judge you and the hospital by the qualities of your entire team. The teamwork begins with the first telephone call the patient makes to schedule an appointment. In most practices, the telephone is the main interface with patients and referring physicians; therefore, this initial telephone conversation must be answered promptly with a friendly and helpful attitude.

The receptionist must discreetly find the reason for the requested visit and make a decision about urgency. Generally, patients with pain, an abscess, or a presumed cancer need early or urgent appointments.

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The receptionist must have a medical professional—a nurse or a doctor—whom they can call upon if the course of action is uncertain. Sometimes, patients may be reluctant to discuss anorectal problems on the phone. If hesitancy is recognized, it is often wise prostate volume calculator mskcc to question further, and instead turn the discussion toward sending or bringing records from the referring physician.

If there is time, the confirmation of the appointment and what is required should L. Smith and A. Kumar be sent by mail. Prostatita foliculara patient needs to know that in order to accomplish as much as possible during the first visit, he or she needs to provide pertinent records, such as color copies of colonoscopy reports, operative reports, digital files of imaging studies, laboratory reports, pathology reports, and sometimes even pathology slides.

If a mailing goes out, forms for demographics, insurance, and medical history could be included in order to save time during the registration process. No patient wants to get lost, prostata juckt providing a map for travel, parking, and public transportation is prostate volume calculator mskcc. Figure 1.

Tangible and clear communications like these convey to the patient the sense of a plan being formed. Choosing a staff member for telephone scheduling and counseling is no trivial matter.

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Whatever attitude the patient is greeted with, or whatever frustrations they harbor from the obstacles they had to surmount to get to you, will be present when you begin your evaluation. Some will have the patient call and make an appointment without providing any information.

Others will give the patient background records and studies to pass on, and some may even send a cover letter requesting the referral with records and studies included. Sometimes, a referring physician may be the first person to call regarding the patient and his problem.

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Listening to a long and time-consuming recorded message can lead to a hang-up and the loss of a referral. It is provided to referring polakiurie în prostatita cronică who call frequently.

The referring doctors message needs to be conveyed to the surgeon whether he or she is in the office or the operating room. A good experience for referring physicians makes it more likely they will call again. If the surgeon cannot be reached, staff should arrange an appointment for the patient and promise that the surgeon will be alerted so that a return call can be made.

AS Kumar I am in contact with many of my referring physicians by e-mail. My referring providers appreciate how rapidly I get the issue settled. They enjoy knowing that the loop is closed. Often, the e-mail interaction with the referring physician is simply a quick reply that is forwarded to my front desk staff to schedule the appointment. On occasion, my front desk staff has been willing prostate volume calculator mskcc e-mail the patient prostate volume calculator mskcc additional information.

Some practices rely almost exclusively on new patient referral requests coming through the Internet and hire staff specifically with this intent. We look at the appointment schedule to review new patients and their diagnoses. We grew accustomed to doing so in residency when preparing prostate volume calculator mskcc an upcoming clinic or a case.

If we see that prostate volume calculator mskcc neoplasm or pain is involved and the appointment seems to be too far in the future, we either alert a nurse to get more information or indiferenta doare la barbati the patient ourselves to hear an abbreviated history.

At that time, we can reassert the need to bring the appropriate records and decide if it is best to move the appointment up, or delay it for completion of studies that may have been ordered by the referring physician, or that we think to order. A simple call creates an early bond that reassures the patient that you have their interest at heart and that communication lines between patient, the referring physician, and you are wide open. In addition, word of this call may be transmitted to the referring doctor, who will be appreciative of your efforts.

The Initial Encounter Key concept: Oftentimes, the first impression is your best chance for a good impression—remember your appearance, demeanor, communication, and your organization have a major impact on how you are judged by your patients.

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The second chance to be judged by the patient is upon arrival in the office. Quick, amiable, competent service is how you like your office to be represented. At evaluations of staff, these qualities need to be reinforced.

Entry of data into the electronic medical record must be as accurate as possible so that you and others can easily access dependable records in your practice and hospital.

This electronic record is impressive to patients and creates a sense that they are in a technologically advanced setting. Hopefully, the appointment schedule runs on time. Patients often value their time as much as you do. There will be days when surgery runs overtime, an outpatient shows up in the emergency room, or a patient is found to be in trouble while on rounds.

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Anticipate these delays as early as possible and have a policy that gives patients the option to reschedule or that estimates a realistic wait time. Generally, patients understand unexpected situations and delays in a hospital; they L.

Kumar imagine that if it were them that needed urgent attention, they would appreciate the priority. Your desire prostate volume calculator mskcc excel in the operating room is self-evident to your staff and patients. Apologize to the long-waiting patient when you arrive late, but only the briefest explanation of what detained you is necessary.

How you dress is a sign of respect for your patient. What is in fashion has changed, and there has been a trend toward informality.

An exception is the military and uniform of the day. Sometimes, you or the staff wear surgical scrubs in order to save time when rushing to get to the office. This should be a rare occurrence because, with good planning, the office schedule should not be a reason to hurry an operation. We encourage dressing with the respect that is warranted when you tell a patient he has a chronic disease or a late-stage or incurable cancer. As styles change, consider what you would wear to church, a wedding, a job interview, or a funeral.

While a serious medical event is run-of-the-mill for you, the patient sees it as a singular, personal, and even life-changing medical problem. Prostate volume calculator mskcc you prostate volume calculator mskcc telegraphs respect or disrespect to the family of a patient and also prostate volume calculator mskcc your staff know what is expected of them in the way of appearance.

After a short time in the waiting room, the patient usually sees a nurse or nursing assistant who takes vital signs as part of the physical examination.

The basic forms for the review of systems, past medical history, surgical history, and medications and administration times may be entered into the record by the nurse as well.

This is an unprecedented time. Volume of an ellipsoid like the prostate, hematoma, etc. Normal prostate, The prostate cancer volume calculator can find the prostate volume and tumour density. Enter the width, height, length of the prostate and the psa value in the prostate cancer volume calculator to find the prostate cancer density measurement.

These records need prostate volume calculator mskcc be reviewed, updated, or corrected by the surgeon at a later point during the evaluation. This record handling is another opportunity to demonstrate professionalism and competency and to reassure the patient.

In a teaching setting, the student or resident may start with the patient to gather a history. The patient and family appreciate a formal introduction. To let the patient know you have his or her facts committed to memory, you might review the salient points of their story back to them, asking for confirmation.

Alternatively, you can request that the pertinent history is repeated to you again to seal it in your mind. The Physical Examination The physical examination can be performed with the team member nurse, student, or resident and surgeon together.

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Usually, this will be the abdominal examination, digital rectal 7 1 The First Encounter examination, anoscopy, and sigmoidoscopy. A team-oriented physical examination also helps to sell your team as a competent unit. If a sink is in the examination room, wash your hands in front of the patient both before and after the examination. Patients appreciate this after prostate volume calculator mskcc much publicity regarding cine și ce tratează prostatita safety promoted by hand washing.

If you traditionally examine prostate volume calculator mskcc patient in the knee-chest position, consider installing a curtain to be drawn in front of the exam room door. Patients feel vulnerable not being able to see what you are about to do. Talk the patient through every part of the examination.

Predict what the patient may experience and give a warning that a finger is entering the anus or vagina, or estimate and verbalize the size of an instrument relative to your finger.

Let them know that an urgency to defecate is normal and not to move if a cramp occurs. We have found that a letter sent to the patient prior to the appointment which explains that a rectal exam is a standard part of a colorectal first encounter, helps establish a sense of preparedness for this intimate and sometimes uncomfortable part of the exam. Also, suggest to patients that they consider clearing their rectal vault of any contents by self-administering an over-the-counter saline enema 2 h prior to the visit.

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This is something that, when done in the privacy of home, helps the patient mentally prepare for what may ensue during your examination. If prostate volume calculator mskcc is elicited, perform the painful examination only once. In any case, an effort to minimize pain will endear you to your patient. For example, lubricate the finger or instrument liberally and be gentle. If you see an prostate volume calculator mskcc fissure, do not feel obligated to perform a digital rectal examination or anoscopy on the first visit.

Sometimes, asking the patient to push out against your finger not only relaxes the muscles but gives the patient an action to focus on so that he or she will not immediately tense up when sensing your hand nearby. If the pathology is favorable, consider telephoning the patient to relay the good news. This demonstrates to the patient that you are thinking of him or her. Do not put off the call. Often, the patient is anxious and waiting by the phone.

If a weekend is near, and the result is favorable, telephone them with the happy result, even if it is late on Friday night. Waiting and not knowing a pathology result exacerbates patient consumul de hrean pentru prostatită. If the pathology is foreboding, wait for the scheduled appointment or move the appointment sooner.

AS Kumar I employ e-mail to communicate with many patients about their pathology. If e-mail is an option, we can spend a few extra minutes at the initial encounter itself, talking through the potential next steps based on the outcomes of the pathology report. The e-mail that I ultimately send encloses a digital version of their entire report and includes a summary of my impressions.

I ask the patient to reply with a phone number and a good time for me to call to discuss it further.

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This step empowers the patient, since many like to keep shadow copies of their medical records and also like the opportunity to share the diagnoses with the primary care provider. Sophisticated electronic personal health systems employ a web portal where patients log in to see their personal health record and interact with their physicians. This allows them to access their laboratory and pathology reports and correspond with their physicians via the secure portal Fig.

The Team and Teaching Conveying Pathology Results When biopsies are taken or a biopsy result is outstanding, have the patient schedule an appointment within the week to come back prostate volume calculator mskcc learn the result and plan the ensuing Key concept: Each member of the team plays a critical role— ensure the patient understands who everyone is and what that role encompasses. Have several different platforms i. Kumar Fig. The information contained in this communication may also be protected by legal privilege, federal law or other applicable law.

If you are not the intended recipient of this communication, you are hereby notified that any distribution, dissemination or duplication of this communication is prostate volume calculator mskcc prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication.