Block 2 Flashcards
What are the 3 main models of doctor-patient relationships?
Paternalistic
Informed
Shared
What is the paternalistic model of doctor-patient relationships?
Doctor-led approach in which doctor makes systematic enquiries and patient takes a passive role – decisions made mainly by doctor
What are the pros and cons of the paternalistic model of doctor-patient relationships?
Pros: appropriate in some situations (e.g. emergencies or patient preference), underlying ethical principle of beneficence
Cons: best interest of patient is subjective (link to VLE – concepts of best interests)
What is the shared model of doctor-patient relationships?
Two-way exchange between doctor and patient in which doctor provides medical expertise and patient provides personal expertise – advocated model in the UK
What are the pros and cons of the shared model of doctor-patient relationships?
Pros: facilitates autonomy, shared responsibility
Cons: patient access to information and ability to process complex information (situation-dependent), communication difficulties
What is the informed model of doctor-patient relationships?
Patient-led approach in which doctor’s role is to communicate all relevant information and options to enable patient to make an informed decision
What are the pros and cons of the informed model of doctor-patient relationships?
Pros: appropriate in some situations (e.g. cosmetic surgery), emphasis on autonomy
Cons: possible to information overload (thus reducing autonomy) – link to Montgomery judgement which set precedent of how much information is valid for decision making, potential psychological harm of make a decision resulting in a poor outcome
What is healthy life expectancy?
Number of years expected to live in ‘good health’
What is the epidemiological transition?
How social and economic development leads to transitions in the demographic disease profile (shift from deaths from acute infections and deficiency diseases to deaths from chronic and non-communicable diseases as countries move through stages of development)
What are the leading causes of death in the UK?
Mixed = dementia
Female = dementia
Male = ischaemic heart disease
Leading cause of cancer death (mixed) = lung cancer
Define health inequality
Systematic differences in health outcomes between social groups
What is the social gradient of health?
Health outcomes poorer the lower down the socioeconomic ladder
What is the behavioural/ cultural model of health inequality?
Variations in health behaviour and lifestyle (as a result of individual choice, knowledge of culture) explains inequalities in health – negative health behaviours follow social gradient
What is the materialist/ neomaterialist model of health inequality?
Social inequality a strong determinant of health inequality – increased cognitive stress can impact decision making ability – material deprivation at individual and community level linked to poorer health outcomes
What is the psychosocial model of health inequality?
The way people’s environment makes them feel is linked to health inequality – psychosocial stress both directly and indirectly impacts health (directly through neuroendocrine stress pathways and indirectly through adoption of unhealthy behaviours)
What is relative poverty?
Stress related to feeling less well off than those around you
What is the lifecourse effects model of health inequality?
Material, behavioural, psychosocial and biological processes that operate independently, cumulatively and interactively across an individual’s life course, or across generations, to influence the risk of developing disease
Define sex
Biologically-determined, physical characteristic differences between males and females
Define gender
Socially constructed roles, behaviours, attitudes and attributes that a given society deems appropriate for males and females
Define heteronormativity
Society’s assumption that relationships between the opposite binary sex individuals are the norm (heterosexual relationships)
Define gender identity
Internal sense of one’s own gender
Define transgender
Umbrella term used for people whose gender identity differs from the sex/ gender they were assigned at birth
What biological differences can be used to explain higher morbidity rates in males?
Immune system differences (female immune systems respond better than males but increased risk of autoimmune disease) Hormone differences (e.g. oestrogen a protective factor for CHD until menopause when risk becomes higher than in males) Cardiovascular reactivity Neuroendocrine response
What health behaviours can be used to explain morbidity rates in males and females?
Higher smoking rates and alcohol consumption in males - strong association between heavy drinking, depression and suicide in males
‘Masculine’ health behaviours (e.g. coping strategies for stress)
Males less likely to see a doctor
Caring deemed a ‘women’s role’ (care work associated with physical and mental ill-health)
What is the difference between gender health differences and gender health inequalities?
Gender health differences refer to things that only occur in one sex (e.g. prostate cancer in men)
Gender health inequalities refer to a situation where a particular gender tends to have worse outcomes than the other (e.g. breast cancer prevalence higher in women but outcomes worse in men – higher mortality rate)
Why should the term ‘race’ no longer be used?
Historically used to argue that inherent biological differences exist between different populations (and used to support the notion of some populations being superior/ justification of subjugation of some populations)
Discredited term - populations are physically and genetically more similar than different
Define ethnicity
Two common characteristics separating one ethnic group from another:
Long, shared history
Cultural traditions
Define culture
The ideas, customs and social behaviour of a particular society (or group of people) - influences individual perception and behaviour
What is ethnic inequality in health?
Refers to the fact that ethnic minority groups tend to have poorer general health than the white majority population (in the UK) and poorer health outcomes (e.g. higher infant mortality rate)
Name one ethnic inequality in health
T2D:
Those of South Ssian descent 6x more likely than white population and those of African/ Afro-Caribbean descent are 3x more likely than white population
What is the Salmon Bias?
Refers to the fact that migrants may return to their country of origin when ill which could artificially reduce the mortality rate in the migrant population
Give 2 possible explanations for ethnic inequalities in health
- Epigenetics (interaction between genes and environment)
- Stressful experience of migration and settling in new country can cause decline in health (obviously not applicable to everyone)
What is the difference between direct and indirect racism?
Direct = people being treated less favourably because of their ethnicity or religion Indirect = people being unaware that their actions are undermining the position of people from ethnic minority groups
What is institutional racism?
The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin
What is the difference between health promotion and disease prevention?
Health promotion = enabling people to control their own health
Disease prevention = actions aimed at eradicating or minimising the impact of disease or disability (or the progress of)
What is primary disease prevention?
Actions aimed at avoiding disease from occurring in the first place (e.g. immunisations and health education)
What is secondary disease prevention?
(latent or early stage of disease) - early detection and treatment of disease (e.g. through screening programmes and intervention)
What is tertiary disease prevention?
(At symptomatic stage of irreversible disease) - actions aimed at limiting the damage of disease to reduce severity and maximise quality of life (e.g. through rehabilitation and pain management)
What is the difference between individual and population strategies for disease prevention?
Individual = identify and target those at high risk Population = directed at everyone irrespective of risk level
What are the strengths and weaknesses of an individual approach to disease prevention?
Strengths: high motivation (for doctors and patients)
Weaknesses: resource allocation; stigmatises individuals; no lasting change at population level
What are the strengths and weaknesses of a population strategy for disease prevention?
Strengths: benefits population as a whole; more permanent; attempts to control root cause of disease; shifts cultural norms
Weaknesses: benefit is small for individuals (Rose’s prevention paradox); low motivation
What is Rose’s Prevention Paradox?
Preventative measure that brings large benefits to the community offers little to each participating individual
What are Ewles + Simnett’s 5 approaches in health promotion?
Medical (screening, immunisations)
Behavioural (encouraging healthy behaviours)
Educational (provision of information to facilitate individual choice)
Client centred
Societal (policy and legislation changes)
What are the 3 A’s used to give ‘very brief’ advice in MECC?
Ask
Advise
Act (refer)
What are the 5 A’s used to give ‘brief’ advice in MECC?
Assess Advise Agree Assist Arrange (refer)
