How patients can help us be even better doctors - educational leaflet "Before I go to the doctor".

BACKGROUND: Medical psychology research shows that how a patient communicates appears to be the strongest predictor of physician behavior during a consultation and that patient's activity also influences how much information a physician communicates to a patient about his or her illness and treatment. Thus, being a patient is a skill that needs to be developed to balance the responsibilities of doctors and patients in each of their encounters. There is a lack of clear recommendations and education in this area, and patients' behaviour is instead governed by the etiquette of courtesy. PURPOSE: The main aim of this article is to create a list of recommendations for patients and physicians to develop the skill of a competent patient in mutual communication and to include these recommendations into an educational leaflet with the aim to support the diagnostic and therapeutic process and personalized care. MATERIAL AND METHODS: Literature sources were selected unsystematically for the purpose of a narrative review, guided by the question: "What patient skills and competencies promote effective communication with the physician?" We adopted the snowball method, sometimes referred to as chain or reference selection, to generate the list. RESULTS: The results of the current narrative review demonstrate that the topic of patient communication competencies interests researchers and clinicians across medical disciplines. A summary of patient competencies was developed into an educational handout entitled "Before I go to the doctor". The leaflet can be freely distributed in a printed form, as presented in the article, or patients can be referred to its electronic version (via QR code on the leaflet or on the website of the Department of Medical Psychology and Psychosomatics of the Faculty of Medicine, Masaryk University, in the educational materials section at https: //upp.med.muni.cz/zdroje/edu). The educational leaflet can be used as educational material in any healthcare facility. CONCLUSION: Being a competent patient is an ideal state that we strive for from the position of patients and physicians in order to develop medicine more symmetrically, in partnership and with an optimal distribution of responsibility for health, illness and treatment. The information leaflet is one of the possible and fundamental interventions to develop the skill of competent communication on the part of the patient. It is the most commonly used communication channel in patient education. The current list of recommendations is not definitive and binding. However, it opens up the topic itself. It names the dimensions of doctor-patient communication and gives both parties the opportunity to consider what their relationship should be like, what is missing in this relationship, and what is important to both parties.

Some Unresolved Ethical Challenges in Healthcare Decision-Making: Navigating Family Involvement.

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making.

Unusual presentation of plasmablastic lymphoma involving ovarian mature cystic teratoma: a case report.

BACKGROUND: Plasmablastic lymphoma (PBL) is relatively new clinical entity described as a distinct subtype of diffuse large B-cell lymphoma (DLBCL). It is characterized by its aggressive nature and proliferation of large neoplastic cells resembling immunoblasts including cells with more obvious plasmacytic differentiation. In this case report, we describe an unexpected finding of PBL associated with a mature cystic teratoma of the ovary in a young immune competent woman. CASE PRESENTATION: A 19-year old woman was admitted to the hospital with generalized lymphadenopathy, a pelvic tumor mass measuring 35 × 30 cm and a 4 cm lump in her right breast. She underwent a right salpingo-oophorectomy, lymphadenectomy, splenectomy, omentectomy, and a right breast lumpectomy. On macroscopic examination the right ovary was replaced by a thick-walled multilocular cystic tumor. Upon incision, the cysts were filled with thick, greasy sebaceous material and hair and there were several solid nodules within the cyst walls. Histological examination revealed a mature cystic teratoma and malignant non-Hodgkin lymphoma (NHL) within the solid nodules. Tumor tissue from the right breast, spleen and lymph nodes, all had the same histological, NHL morphology. After extensive immunostaining, a diagnosis of PBL was made. Following surgery, the patient was treated with different chemotherapy regimens, without any significant regression of the disease, and died of multiple organ failure. CONCLUSIONS: Primary NHL of the ovary is relatively rare occurrence while secondary involvement by lymphoma is much more common. PBL is a rare lymphoma, primarily reported in the jaw and oral mucosa, but also documented in extra-oral sites. To the best of our knowledge, this is the first case described in a mature ovarian cystic teratoma. Although the patient was HIV-negative and immune competent, she had progressive disease and died despite aggressive chemotherapy 11 months after the initial diagnosis.