2014 Flashcards
What effects might working offshore have on the worker’s, and their family’s, physical health?
Might be too tired to do long shifts
Dangers of working on an oil rig
Dangers of transportation to the oil rig
Adjustment to day / night shift patterns
Potential for obesity due to abundance of food in canteen
Potential for improved physical health in James if he makes use of healthy eating options & facilities offshore
Partner might be tired of the ‘single-parent’ role when James
What effects might working offshore have on the worker’s, and their family’s, psychological health?
Anxiety & stress due to dangerous working environment / separation from family
Both might be anxious about the security of his employment in the current economic climate
Anxiety & stress about uncertain return home (weather delay)
Anxiety & stress about helicopter journeys
Possible depression in either due to repeated periods of isolation
Anxiety & stress in children due to separation / father’s job
What effects might working offshore have on the worker’s, and their family’s, social health?
Relationship difficulties due to nature of job
Able to spend additional time with family and friends during onshore periods
Discipline problems in children due to ‘absent’ father figure
Substance misuse due to stressful nature of job
Well paid employment allows family to afford good lifestyle, decent car, to go on holiday
No smoking / alcohol when offshore
May binge drink when onshore
Categories of hazard
Mechanical Physical Chemical Biological Psychological/stress
An offshore worker is made redundant, what effect might this have on his wife’s health?
Exhaustion due to working extra hours to maintain family finances
Worry / stress about the entire family’s future
Anger that the husband has been made redundant
Stress at husband being at home all the time = change of friendly dynamics
Enjoyment of increased time to spend with husband
Positive future outlook with possibility of husband gaining more family-friendly employment
An offshore worker is made redundant, what effect might this have on his health?
Feelings of worthlessness
Guilt that he is no longer supporting his family
Anxiety about finding another job / retiring
Depression
Anger at his employer’s
Positive outlook for new future employment
Enjoyment of more time with family
Substance misuse as coping mechanism
A patient attends for a routine appointment and asks you about her husbands health; how would you deal with this enquiry?
Maintain her husbands confidentiality Consider need to maintain the husband's trust Consider GMC guidelines Acknowledge her concern Ask why she is concerned
Ethical principles
Beneficence
Non-maleficence
Justice
Autonomy
Define culture
Complex whole which includes knowledge/beliefs/art/morals/law/customs
or
Systems of shared ideas, systems of concepts, rules and meanings that underlie and are expressed in the ways that human beings live
Define ethnicity
Cultural practices and outlooks that characterise and distinguish a certain group of people; characteristics identifying an ethnic group may include a common language, common customs and beliefs and tradition; term preferred over ‘race’
Define race
A group of people linked by biological/genetic factors
Difficulties which may arise in a consultation as a result of cultural differences
lack of knowledge about health issues fear / distrust racism bias / ethnocentrism stereotyping ritualistic behaviour language barriers 3rd part presence (family members etc) differences in perceptions / expectations examination taboos gender difference between doctor / patient religious beliefs difficulties using language line
Aspects of social health that you might want to discuss in a consultation
Smoking Sexual health Alcohol Illicit drugs Exercise Diet/eating patterns Family influence Peer pressure to smoke
What are the social classes according to the 1911 Census?
Professional Managerial and technical Skilled non-manual Skilled manual Partly skilled Unskilled
How might culture influence smoking behaviour in different social classes?
Lower social classes see larger numbers of people around them smoking and are more likely to accept it as normal behaviour
Those around them are also more likely to accept the start of another individual smoking as normal behaviour (no stigma attached)
Reasons for differences in trends of obesity in different cultural groups
early life experience education cooking facilities / ability cost of healthy food cultural expectations access to good quality food provision carry-out culture unhealthy budgeting choices
Primary care professionals who have a role in obesity management and what they might do
Dietician = individual dietary advice
Pharmacist = general advice; OTC anti-obesity medication; weight management programmes
Health visitor = health education; advice on healthy diet
GP = advice; prescription of weight reducing drugs
Practise nurse = weight clinics; general dietary advice
Midwife = encourage breast feeding; early dietary advice
What are the 3 models of stress?
Engineering model
Medico-phsyiological model
Psychological/transactional model
Describe the engineering model of stress
Stress acts as a stimulus which the individual must resist
If the stimulus becomes too intense or prolonged, the individual breaks
Types of coping mechanism
Problem focused
Emotion focused
Combination of problem/emotion focused
Define incidence
number of new cases of a disease in a population in a specified period of time
Define prevalence
Number of people in a population with a specific disease at a single point in time or in a defined period of time
Describe the guidance/co-operation style of doctor-patient relationship
The doctor exerts a degree of authority and the patient is obedient
The patient does have a little feeling of autonomy and participates to a small degree in the relationship
What are the styles of doctor-patient relationship described by Szasz and Hollender (1956)
Authoritarian/paternalistic
Mutual participation
Guidance/co-operation
Questions that may be used in medical interviewing and describe them
open questions = not seeking any particular answer but simply signals the patient to tell their own story
direct questions = asks about a specific item
closed questions = can only be answered by yes or no or an equivalent
reflected questions = allows the doctor to avoid answering a direct question from the patient / aids the doctor in exploring the patient’s own thoughts and perceptions
leading questions = presumes the answer; best avoided
What is a gatekeeper?
A person who controls patients’ access to specialist or secondary care
Advantages of GP as a gatekeeper
keep people out of expensive secondary care
continuity of care (knowledge of the patient)
personal advocacy
patient does not know where to go
referral to appropriate department
limiting exposure to certain investigations (e.g MRI scan)
Disadvantages of GP as gatekeeper
patients have less choice in secondary care
places stress on GP to know everything about every disease / symptom
dependent on individual GP knowledge, attitudes, skills (and practise organisation)
referral may be hampered by bad doctor-patient relationship
seeing a GP might increase the time it takes to see a specialist and receive treatment
dissatisfied patients may inappropriately present to A&E or the private sector
How any patients are registered on average with each GP in the NHS in the UK?
1200-2000 patients each
What percentage of illnesses presenting to primary care are referred on to secondary care?
3%
