B1 Foundations of Medicine Flashcards
What is the exocytic pathway?
rER (protein synthesis) –> Golgi apparatus (modification) –> Small transport vesicles –>’trans’ face of Golgi –> plasma membrane/ secretory granules/ Other organelles
What is the alternative to regulated secretion?
Constitutive secretion
What is glycosylation?
Adding a polysaccharide chain to lipid/ protein etc
What are secretory granules
Organelles that store substances for regulated secretion in response to a signal
What is a lysosome?
A vesicle with enzymes that can break down stuff - waste disposal system of cell. a.k.a suicide sacs
Why is patient centred care important?
- Explores patient’s main reason for visit, concerns and need for info
- Seek integrated understanding of patient’s world
- Find common ground on what the problem is and how to deal with it
- Enhances prevention and health promotion
- Enhances relationship between patient and doctor
- Realistic
What is the sick role of the patient?
- Must want to get well as quickly as possible
- Seek professional medical advice and co-operate with doctor
- Allowed/ expected to shed some normal activities and responsiblities
- Regarded as being in need of care and unable to get better by his/her will
What are the expectations of the doctor regarding ‘the sick role’?
- Apply high degree of skill and knowledge to problems of illness
- Act for welfare of patient and community rather than self interest
- Be objective and emotionally detached
- Be guided by rules of professional practise
What are the rights of thedoctor in relation to ‘the sick role’?
- Examining patients physically and enquire into intimate areas of physical and personal life
- Considerable autonomy in professional practise
- Occupies position of authority in relation to the patient
What are the models of clinical decision making?
- Professional choice
- Shared decision making
- Consumer choice
What is the difference between ‘professional’ and ‘consumer choice’ decision making models?
Professional - Clinician decides, patient consentsConsumer - Clinician informs, patient decides
What is the definition of patient-centred care?
Health care that is closely congruent with and responsive to patient’s wants, needs and preferences
What is opportunity cost?
Making a choice as a clinician - the value of what you give up for one patient when you make a treatment decision for another patient
What point on the ‘Flat of Curve’ graph is ideal?
A (Beginning)
What is the most important thing in explaining variation in costs? Increasing age or number of conditions?
Number of conditions
Who is involved in management of funds?
Department of Health
What groups are involved in purchasing goods in the NHS?
CCGs- Clinical Commissioning Groups
True or False? There is no such thing as a free market?
True
What is demand inversely related to in markets?
Price
What is supply positively related to?
Price
When would the market be in equilibrium?
When demand is equal to supply
Why is opportunity cost important?
Resources are always scarce.
What is ethics?
The study of what makes an action right, wrong or permissible.Also concerned with what character traits are the right ones to develop.
What is meta-ethics?
Study of the meaning of moral concepts
What is nominative ethics/ moral theory?
Study of the means of deciding what action is the right one
What is applied ethics?
The application of moral theory and principles to actual cases/ real life issues
What two types of ethics is medical ethics mostly concerned with?
Nominative ethicsApplied ethics
True or false? Ethics in medicine is ubiquitous - every decision made will require some ethical justification
True
What are the three main types of moral theory?
ConsequentialismDeontologyVirtue Ethics
What is consequentialism?
One of the main types of moral theory; the rightness of the action is determined by the desirability of the consequences that result from the action
What is ‘act utilitarianism’?
An influential consequentialist theory. The right action is always the one that maximises overall happiness
What is preference satisfaction?
Form of utilitarianism that promotes the action that fulfills the preference of those involved.This doesn’t necessarily maximise happiness.
What is deontology?
Duty-based ethicsActs are right if they accord with the system of rules or duties. (e.g. The Ten Commandments)Not right because of the virtue of their consequences.
What is virtue ethics?
The right act is the one a virtuous person would perform in the circumstances.Virtues are the character traits and dispositions needed for human flourishing. (E.g. compassion)
What is the opposite of a virtue?
Vice
What is the four principles approach?
Beuchamp and ChildressAutonomyBenevolenceNon-MaleficenceJustice
What does the prinicple of justice mean in practice?
Society provides a minimal but decent level of health care for allEnsure health care resources and services are distributed in a fair and equitable (non-discriminatory) way
What does ‘prima facie’ mean?
- At first appearance/ sight - not absolute obligations
- Fact assumed to be true unless trumped
Each one of the four principles should be followed unless it conflicts with an equal/ stronger moral obligation
What is the consequential reason for autonomy being important?
Generally leads to better consequences or outcomes for patientsE.g more likely to trust doctors if they are more centrally involved in the decision-making process
What is the deontologist reason for autonomy?
According to Kant we should respect people’s autonomy because by doing so we treat people as ends and notas means to an end (more virtuous)
What is a negative obligation in relation to autonomy?
Autonomous actions should not be subjected to controlling constraints by others.E.g. Patients should not be under the pressure of others, like family, to make a certain decision
What is a positive obligation in relation to autonomy?
Respectful treatment in disclosing information and actions that foster autonomous decision making
What is always required before treating patients?
Valid consent
True or false? Patient confidentiality ties into the principle of autonomy
True
What is important with consent?
CapacityUnderstandWeigh UpCommunicate
What are the things that need to be understood for a best interests assessment?
NeedsPrioritiesConcernsValues(Going beyond what medical expertise alone can tell you)
What are the main difficulties in assessing best interests?
- Future uncertain- hard to predict long term effects of the intervention
- When weighing conflicting goods
- Own emotional attachments distort views about what is in a person’s best interests
- Doctor’s and patients views may be conflicting
What is paternalism?
Interference with a person’s freedom of action or freedom of information for their own goodThe deliberate dissemination of misinformation justified by reasons referring to the welfare, good, happiness, needs, etc. of the patientCan concern coercion
Is paternalism accepted today?
Almost universally unacceptable
What are exceptions to the anti-paternalistic way of treating a patient?
Withholding informatoon relevant to treatment decision where sharing this information is likely to lead to serious harm of the patientTreatment of infants and children, patients who lack capacity and mentally ill adult patients who satisfy legal criteria for compulsory detainment and treatment
True or false? A doctor is not required to always give treatment?
True- If the doctor considers such treatment would provide no clinical benefit
True or false? By law patients are allowed to make ‘unwise’ decisions
True- Provided they’re in their right mind and communicate reasoning
True or false? ‘Best interests’ and ‘autonomy’ mean the same thing?
False - Autonomy means that the action plansthe doctor creates with the patient may not necessarily be in the patients best interests - They have the right to refuse treatment
What are pseudopods?
Temporary or semipermanent extension/ projection of a cytoplasm
