Block 2

Question 1

What are the 3 main models of doctor-patient relationships?

Answer 1

Paternalistic
Informed
Shared

Question 2

What is the paternalistic model of doctor-patient relationships?

Answer 2

Doctor-led approach in which doctor makes systematic enquiries and patient takes a passive role – decisions made mainly by doctor

Question 3

What are the pros and cons of the paternalistic model of doctor-patient relationships?

Answer 3

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)

Question 4

What is the shared model of doctor-patient relationships?

Answer 4

Two-way exchange between doctor and patient in which doctor provides medical expertise and patient provides personal expertise – advocated model in the UK

Question 5

What are the pros and cons of the shared model of doctor-patient relationships?

Answer 5

Pros: facilitates autonomy, shared responsibility
Cons: patient access to information and ability to process complex information (situation-dependent), communication difficulties

Question 6

What is the informed model of doctor-patient relationships?

Answer 6

Patient-led approach in which doctor’s role is to communicate all relevant information and options to enable patient to make an informed decision

Question 7

What are the pros and cons of the informed model of doctor-patient relationships?

Answer 7

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

Question 8

What is healthy life expectancy?

Answer 8

Number of years expected to live in ‘good health’

Question 9

What is the epidemiological transition?

Answer 9

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)

Question 10

What are the leading causes of death in the UK?

Answer 10

Mixed = dementia
Female = dementia
Male = ischaemic heart disease
Leading cause of cancer death (mixed) = lung cancer

Question 11

Define health inequality

Answer 11

Systematic differences in health outcomes between social groups

Question 12

What is the social gradient of health?

Answer 12

Health outcomes poorer the lower down the socioeconomic ladder

Question 13

What is the behavioural/ cultural model of health inequality?

Answer 13

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

Question 14

What is the materialist/ neomaterialist model of health inequality?

Answer 14

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

Question 15

What is the psychosocial model of health inequality?

Answer 15

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)

Question 16

What is relative poverty?

Answer 16

Stress related to feeling less well off than those around you

Question 17

What is the lifecourse effects model of health inequality?

Answer 17

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

Question 18

Define sex

Answer 18

Biologically-determined, physical characteristic differences between males and females

Question 19

Define gender

Answer 19

Socially constructed roles, behaviours, attitudes and attributes that a given society deems appropriate for males and females

Question 20

Define heteronormativity

Answer 20

Society’s assumption that relationships between the opposite binary sex individuals are the norm (heterosexual relationships)

Question 21

Define gender identity

Answer 21

Internal sense of one’s own gender

Question 22

Define transgender

Answer 22

Umbrella term used for people whose gender identity differs from the sex/ gender they were assigned at birth

Question 23

What biological differences can be used to explain higher morbidity rates in males?

Answer 23

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

Question 24

What health behaviours can be used to explain morbidity rates in males and females?

Answer 24

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)

Question 25

What is the difference between gender health differences and gender health inequalities?

Answer 25

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)

Question 26

Why should the term ‘race’ no longer be used?

Answer 26

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

Question 27

Define ethnicity

Answer 27

Two common characteristics separating one ethnic group from another:
Long, shared history
Cultural traditions

Question 28

Define culture

Answer 28

The ideas, customs and social behaviour of a particular society (or group of people) - influences individual perception and behaviour

Question 29

What is ethnic inequality in health?

Answer 29

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)

Question 30

Name one ethnic inequality in health

Answer 30

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

Question 31

What is the Salmon Bias?

Answer 31

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

Question 32

Give 2 possible explanations for ethnic inequalities in health

Answer 32

1. Epigenetics (interaction between genes and environment)
2. Stressful experience of migration and settling in new country can cause decline in health (obviously not applicable to everyone)

Question 33

What is the difference between direct and indirect racism?

Answer 33

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

Question 34

What is institutional racism?

Answer 34

The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin

Question 35

What is the difference between health promotion and disease prevention?

Answer 35

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)

Question 36

What is primary disease prevention?

Answer 36

Actions aimed at avoiding disease from occurring in the first place (e.g. immunisations and health education)

Question 37

What is secondary disease prevention?

Answer 37

(latent or early stage of disease) - early detection and treatment of disease (e.g. through screening programmes and intervention)

Question 38

What is tertiary disease prevention?

Answer 38

(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)

Question 39

What is the difference between individual and population strategies for disease prevention?

Answer 39

Individual = identify and target those at high risk 
Population = directed at everyone irrespective of risk level

Question 40

What are the strengths and weaknesses of an individual approach to disease prevention?

Answer 40

Strengths: high motivation (for doctors and patients)
Weaknesses: resource allocation; stigmatises individuals; no lasting change at population level

Question 41

What are the strengths and weaknesses of a population strategy for disease prevention?

Answer 41

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

Question 42

What is Rose’s Prevention Paradox?

Answer 42

Preventative measure that brings large benefits to the community offers little to each participating individual

Question 43

What are Ewles + Simnett’s 5 approaches in health promotion?

Answer 43

Medical (screening, immunisations)
Behavioural (encouraging healthy behaviours)
Educational (provision of information to facilitate individual choice)
Client centred
Societal (policy and legislation changes)

Question 44

What are the 3 A’s used to give ‘very brief’ advice in MECC?

Answer 44

Ask
Advise
Act (refer)

Question 45

What are the 5 A’s used to give ‘brief’ advice in MECC?

Answer 45

Assess
Advise
Agree
Assist 
Arrange (refer)