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FPH exam > 4b Healthcare > Flashcards

4b Healthcare Flashcards

1
Q

What is complementary medicine/ alternative therapies? Give some examples

A
  • defined as a group of diverse medical and health care practices and products that are not generally considered to be part of conventional medicine
  1. home made
    ie lemon and honey for a sore throat
  2. Commercial
    ie st johns wort for depression
  3. Self administered practices (ie meditation)
  4. therapies delivered by a practitioner (ie acupuncture)
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2
Q

what is the clinical iceberg?

A
  • the professional health service only treats a very small fraction of the total burden of ill health
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3
Q

what are the implications of the clinical iceberg?

A
  • studies using only health service data use will grossly underestimate the burden of ill health in society
    -the value of conventional health services may be enhanced by recognizing more explicitly the value of different approaches (eg there are situations when alternatives to healthcare services are more appropriate)
  • most healthcare is self care
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4
Q

what is the Kaiser pyramid

A
  • it is a model that depicts the care of people with long term health conditions

-at the wide bottom there are 70-80% of the people with long term conditions. These have a high percentage of self care.
- in the middle there are people who are high risk cases, they have equally shared care.
- at the top there are complex cases with comorbidities, these have a high percentage of professional care

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5
Q

draw the kaiser pyramid

A
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6
Q

Medication sale restrictions: vitamins and supplements

A
  • these are classed as a food supplement and regulated under the Food Safety Act
  • ie vitamin C
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7
Q

Medication sale restrictions: traditional herbal registration

A
  • some herbal remedies have restricted access (ie prescription only) but most are on general sale
    ie St Johns Wort
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8
Q

Medication sale restrictions: General sales list

A
  • available on open shelves ie supermarkets
    ie paracetamol
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9
Q

Medication sale restrictions: Pharmacy list

A
  • can be sold under the supervision of a pharmacist
    ie ranitidine
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10
Q

Medication sale restrictions: Prescription only medication

A
  • only available with a prescription
    ie flucloxacillin
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11
Q

Medication sale restrictions: controlled drug

A
  • only available with a detailed prescription.
  • stored in a locked cupboard with record of distribution maintained
    -eg diamorphine
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12
Q

Give 3 examples of ways in which health services now try to support self care

A
  1. TELEHEALTH
    the use of devices at home to measure patients vital signs (ie BP, blood glucose) and convey that information to health care services. Health car professionals can contact a patient if results become abnormal
  2. EXTRA CARE HOUSING
    A type of adapted housing that is designed to support older people with higher levels of needs to live at home
  3. TRAINING PAITENTS IN SELF MANAGEMENT
    ie expert patient programme
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13
Q

How did Freidson describe family care?

A

-Freidson described how people ten to discuss medical issues with friends/family/colleagues before seeking professional advice. This lay referral system is used for:

  1. interpreting symptoms
  2. reassurance
  3. seeking advice about a remedy
  4. seeking a referral to another lay person or professional (ie you should talk to..)
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14
Q

What does community care mean in the UK?

A
  • As well as forming an important part of the lay referral system the term community care has taken on different meanings in different countries
  • in the UK the NHS and Community Care Act 1990 led to large scale relocation of people with mental illness out of large psychiatric hospitals and into sheltered housing or small local hostels
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15
Q

What are the main functions of self help groups?

A
  • increasing number sof self help groups exisit, nearly for every conceivable disease
  • they conduct a number of functions
  1. source of information on disease
  2. Connect people with the condition
  3. raise funds to support research
  4. lobby government and clinicians for prioritisation of the disease/ needs of affected people

Note some self help groups might receive considerable funds ie from pharmaceutical agencies

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16
Q

talk about how hospitals may act as social institutions

A
  • hospitals may act as social institutions in various ways and thereby shape the culture and practices of their local community
  • they are not only a centre for treatment but may also serve over positive and negative roles in society
17
Q

Name 5 positive influences hospitals may have on society

A

1 EMPLOYER - often the largest employer in the area
2. PURCHASER- large purchaser, can serve community through beneficial purchasing practices
3. COMMUNITY RESOURCE- facilities ie swimming pools, meeting rooms can provide an excellent resource for the community
4. RESEARCH- hospitals are often the site of clinical research’
5. EDUCATION AND TRAINING- undergrad and post grad clinical staff are often trained in hospitals

18
Q

Name 2 positive influences hospitals may have on society

A
  1. POLLUTER- traffic emissions from staff and patients travelling to hospital and large producers of waste

2 ISOLATION OR EXCLUSION- hospitals generally separate people from the rest of the population until they are healthy. At its extreme people with severe infectious diseases may be isolated.

19
Q

Institutionalism: How did Goffman describe total institutions and what did he find about institutionalised patients

A

-Goffman described total institutions as: places were people are ilsated from society over a period of time and lead a life in an enclosed environment that is administered in a formal fashion

20
Q

Institutionalism: What did Goffman find about institutionalised patients

A
  • institutionalised patients became apathetic and progressively less able to make decisions and care for themselves
21
Q

What methods are used currently to mitigate the effects of instituionalism

A
  1. providing information to patients prior to treatment
  2. encouraging mobility and self care in hospital
  3. reduce length of stay
  4. increasing the number of conditions cared for in the community
  5. pre discharge planning and education
22
Q

What were the 3 original professions?

A
  • medicine, lawyers and clergy
  • medicine is often seen as the archetypal profession
23
Q

What are some key features of professions? (there’s a 4 letter mneunonic)

A

CAKE

CERTIFICATION or LISCENCING
(professions have control over certification, restricting entry to the profession)

professional ASSOCIATION
(a profession is self governing giving autonomy)

KNOWLEDGE BASE
Professionals have a knowledge base that is specialised

ETHICAL code
Professions work to an ethical code of practice (which is governed by their professional body)

24
Q

Why was nursing only seen as a semi-profession in the 1960’s?

A
  • lacked the powers of self governance and a specialised body of knowledge (no degree required at that time)
25
Q

professionalisation: what 3 things does the process tend to involve? (an occupation becoming a profession)

A

ABC

  • ACCEPTABLE QUALIFICATION (it has been argued that it was the introduction of a medical degree for doctors that increased credibility)
  • professional BODY (ie GMC to oversee conduct of members)

Occupational CLOSURE (no entry for outsides, amateurs or unqualified)

26
Q

Professional conflicts: give 5 areas of current professional conflict for medics

A
  • NURSING AND OTHER ALLIED HEALTH PROFESSIONS conflict over professional boundaries
  • COMPLEMENTARY PRACTIONERS over their recognition
  • MANAGERS over issues of professional autonomy and control
    -PATIENTS over issues of consumerism and paternalism
  • GOVERNMENT over issues such as terms and conditions of employment
27
Q

What is clinical autonomy?

A
  • autonomy is a key attribute of any profession
  • clinical autonomy refers specifically to the control the profession has over the content and delivery of healthcare
28
Q

Name 5 factors that may limit the clinical autonomy of health care professionals

A

MANAGEMENT
- often sets clinical priorities and monitors standards of care

COSTS
- cost containment practices prevent clinicians always being able to give patients the treatment they would choose

GUIDELINES
- some doctors argue the proliferation of guidelines and protocols have diminished the ability to use clinical judgement
- others argue that evidence based medicine is the best response to falling trust in the profession

COMPETITION
- in a private healthcare system consumer satisfaction is the only way for a provider to remain viable

REVALIDATION
- revalidation and external assessment opens doctors practice up to greater scrutiny including by those outside the profession

29
Q

Illness behaviour: who identified 10 factors that influence peoples behaviour when ill

and what is the mnemonic to remember those 10 factors

A

Mechanic

Very Smart Digs Sit, They Know Dogs Cannot ignore Appetising Treats

30
Q

What are Mechanics 10 factors that influence illness behaviour

A

Very Smart Dogs Sit, They Know Dogs Cannot Ignore Appetising Treats

  1. VISABILITY of symptoms
  2. Perceived SEVERITY of symptoms
  3. Amount of DISRUPTION caused by the symptoms
  4. Frequency and persistence of SYMPTOMS
  5. TOLERANCE threshold (everyone’s has a different ability/ willingness to tolerate symptoms)
  6. KNOWLEDGE, information and assumptions (people differ markedly in their amount of medical knowledge and their beliefs about what causes illness)
  7. Basic needs leading to DENIAL (anxiety about symptoms can prompt health-seeking behaviour or fear of the diagnosis may delay seeking help)
  8. Needs leading to COMPETITION with illness (everyone attributes a different importance to health and other demand (work/family) make take priority)
  9. competing INTERPRETATIONS assigned to symptoms (someone who works long hours may attribute being tired to work not illness)
  10. AVAILABILITY of TREATMENT (access, cost etc)
31
Q

Illness behaviour: cultural differences

A
  • different cultures can respond to illnesses differently
    -pilowski and spence found marked cultural differences between anglo-saxon (stoic, withdrawn) and Mediterranean (emotional) groups
32
Q

Many models of health behaviour help us understand people’s decision making in health, name 4

A
  1. health belief model
  2. Social learning theory
  3. theory of planned behaviour
  4. stages of change

FPH exam (29 decks)

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