Block 43

Question 1

List the 7 criteria which classify a baby as ‘at risk’ of DDH, warranting a referral for US scan.

Answer 1

1) All babies born breech from 36 weeks onwards, breech births (vaginal or caesarean) including those where ECV was carried out.
2) FHx of hip dysplasia or dislocation.
3) Congenital deformity the feet.
4) Clicky hips
5) Unstable hips
6) Limited abduction in flexion.
7) Apparent shortening of one/ both legs.

Question 2

Why can the use of USS to screen for DDH lead to over treatment?

Answer 2

Because USS for DDH has a high sensitivity but a low specificity.

Question 3

1) Pathological DDH is mainly associated with which sex?
2) Describe the PPV of the 6-8 week GP hip check for DDH.
3) What is a useful clinical sign in diagnosis of pathological DDH?

Answer 3

1) Pathological DDH is mainly a female condition.
2) GP 6-8 week hip check has a very low PPV for pathological DDH.
3) Unilateral limitation of hip abduction.

Question 4

Give 3 ways in which abnormal gait/ posture can socially impact upon a patient and they family.

Answer 4

1) Only a small proportion of these abnormalities are clinically significant, but they can cause much parental anxiety.
2) Child may get stigmatised/ bullied for different gait or posture.
3) May become socially withdrawn.

Question 5

Give 3 psychological/ socioeconomic consequences of hip fractures for patients, their families or the wider community.

Answer 5

1) Injury can cause massive change in lifestyle (previously dependent elderly patient may become dependent and require carers).
2) An elderly person suddenly becoming much less independent may lead to social isolation and subsequently depression.
3) In a young person, may mean an inability to get back to playing sports which may lead to depression.
4) 30% mortality within a year.
5) Hip fractures cost NHS £2billion annually.

Question 6

Name 5 risk factors for osteoporosis.

Answer 6

1) Female
2) CKD
3) GI disease/ poor calcium intake
4) Oestrogen deficiency (i.e. menopause)
5) Hyperparathyroidism
6) Increased age
7) Decreased BMI
8) Smoking and alcohol intake

Question 7

Name 3 drugs which can increase the risk of developing osteoporosis.

Answer 7

1) Glucocorticoids
2) Aromatase inhibitors
3) SERMs
4) Anti-androgens
5) PPIs
6) SSRIs

Question 8

According to NICE, which patients may need a falls assessment?

Answer 8

Those aged over 65 who:

1) have had one or more falls in the last 12/12
2) are at risk due to:

• cognitive/ visual impairment
• frailty/ a condition which affects balance (PD, arthritis, stroke)
• taking multiple/ psychoactive/ anti-hypertensive drugs

Question 9

State 2 tests which can be done to assess a patient’s falls risk.

Answer 9

1) ‘Time up and go test’ = patient is timed to get up and out of a chair, walk 3m and then return to the chair. 12-14s = increased risk of fall.
2) 180 degree turn test = ask patient to stand and turn 180 degrees about the spot. If this requires more than 4 steps, there is an increased falls risk.

Question 10

State 5 factors that a multifactorial falls assessment might assess.

Answer 10

1) identification of falls history
2) assessment of gait, balance and mobility, and muscle weakness
3) assessment of osteoporosis risk
4) assessment of the older person’s perceived functional ability and fear relating to falling
5) assessment of visual impairment
6) assessment of cognitive impairment and neurological examination
7) assessment of urinary incontinence
8) assessment of home hazards
9) cardiovascular examination and medication review

Question 11

1) What percentage of the community aged over 65 have a fall each year?
2) What percentage of the community aged over 65 who have experienced at least one fall then have recurrent falls each year?
3) How much more common are falls in institutions compared to in the community?
4) What percentage of those in the community aged over 90 have a fall each year?

Answer 11

1) 30%
2) 50%
3) 3x more common
4) 55% of those over 90 will have a fall each year

Question 12

1) What are the most common cause of injury in the elderly?

2) What percentage of falls cause a hip fracture?

Answer 12

1) Falls

2) 1-2% falls cause a hip fracture.

Question 13

Name 3 consequences of an elderly person having a fall or recurrent falls.

Answer 13

1) Hip fracture (50% no longer live independently after this)
2) Minor injuries (cuts, contusions)
3) ‘Long lie’ leading to hypothermia, pressure sores, pneumonia, rhabdomyolysis, AKI, CKD.
4) Psychological problems (fear of falling, self-imposed activity restriction, loss of mobility, depression)

**note that there are also impacts on carers as the patient often is increasingly dependent and more disabled.

Question 14

Clinically, describe the presentation of a hip fracture.

Answer 14

Characteristically externally rotated and shortened.

**NOF fracture may impinge blood supply to femoral head, leading to avascular necrosis.

Question 15

State the 4 ways in which outcome from hip fractures can be improved.

Answer 15

1) Fast admission.
2) Operate within 24 hours.
3) Mobilise within 24 hours.
4) Initiate early discharge planning with carers.

Question 16

If a patient performs poorly in the ‘time up and go’ and ‘180 degrees turn test’, what might be offered?

Answer 16

A multifactorial falls assessment.

Question 17

Describe 2 ways in which hip fractures can be prevented.

Answer 17

1) Falls prevention

2) Bone protection (bisphosphonates, calcium/ vitamin D supplements, HRT)

Question 18

1) Describe the effect of calcium/vitamin D supplements on preventing hip fractures)
2) Why do bisphosphonates often have poor compliance?
3) What are the risks of taking HRT?
4) By what percentage do bisphosphonates decrease hip fracture occurrence?
5) By what percentage does HRT decrease hip fracture occurrence?

Answer 18

1) Calcium and vitamin D have a modest effect when used in combination but vitamin D does not have an effect when used in isolation.
2) Because daily use causes gastric SEs.
3) Increased risk of DVT, breast cancer and dementia.
4) 30%
5) 20-30%

Question 19

Name 5 risk factors for hip fractures.

Answer 19

1) Increasing age (every 5yrs = 2x increased risk)
2) Female
3) Low BMI
4) Smoking
5) PMHx of fractures
6) FHx of fractures
7) Corticosteroid use
8) Ethnicity (Afrocaribbean = decreased risk)

Question 20

State 3 risk factors for falling along with their relative risk of causing a fall.

Answer 20

1) Muscle weakness (RR - 4.4)
2) Fall Hx (RR - 3)
3) Gait + balance deficit (RR - 2.9)
4) Visual deficit (RR - 2.5)

**Risk varies for different visual problems (depth perception > contrast sensitivity > acuity).

Question 21

Is polypharmacy a risk factor for falls?

Answer 21

It is thought that the risk of fall due to chronic disease and multiple pathologies is higher than the polypharmacy needed to control these.

Question 22

Give 3 ways that Tinetti suggested falls risk can be reduced.

Answer 22

1) Psychotropic drug withdrawal (decreased falls by 66% but also decreased QoL)
2) OT assessment (assess at home risk and make recommendations to decrease risk)
3) Podiatry input (better footwear, orthotic devices, calf-ankle exercises)

Question 23

What are the aims of rehabilitation after a fall causing injury?

Answer 23

Aims are to maximise independence, enable normal ADLs and to maintain social participation.

Question 24

Briefly describe the rehab process following a hip fracture.

Answer 24

Following fracture, patients are referred to an MDT who will coordinate their rehabilitation care.

Question 25

Give examples of 3 professions which work within a hip fracture MDT.

Answer 25

1) PT 2) OT 3) Social workers 4) Geriatricians (some hospitals now have orthogeriatricians)

Question 26

What is the role of an MDT after rehabilitation of a patient who had a hip fracture?

Answer 26

To assess needs for discharge and that the patient is safe to be discharged.

Question 27

Give the leading causes of TBI.

Answer 27

1) Falls - 35.2% 2) Motor vehicle crash - 17.3% 3) Struck by/ against an object - 16% 4) Assaults - 10% 5) Sports-related - 10% 6) Others - 21%

Question 28

1) What is the leading cause of death in children and young adults under 44 years of age? 2) TBI accounts for what percentage of deaths occurring as a result of acute injury? 3) How many attend A&E with head trauma per annum?

Answer 28

1) TBI (10,000 p.a. in the UK) 2) 40% 3) 1 million

Question 29

Describe the distribution of TBIs across the ages.

Answer 29

Trimodal distribution: 1) 5-9 2) 15-24 3) 80+

Question 30

Give 3 risk factors for suffering polytraumas or TBIs.

Answer 30

1) Age 2) Gender 3) >50% transport-related 4) Lower SES 5) Previous TBI 6) Sports and dangerous occupations

Question 31

Describe the positive prognostic factors for TBI (4).

Answer 31

1) Shorter duration of coma (>4 weeks = very poor outcome) 2) Better motor response on GCS 3) Shorter duration of post-traumatic amnesia (>11 weeks is inconsistent with independent living) 4) Younger age (<20 better than >60) 5) Minimal brainstem involvement 6) Premorbid psychosocial status (higher = improved outcomes. **NOTE: site of TBI bears a weak/ no correlation to outcomes.

Question 32

Give 3 different groups of people who may be involved in ongoing assessment of patients after multi-trauma injuries.

Answer 32

1) PTs 2) OTs 3) Speech and language therapy 4) Psychological therapy (CBT) 5) Charities (E.G. HEADWAY - a charitable brain injury association)

Question 33

State the 'yellow flags' for chronicity.

Answer 33

Psychosocial and behavioural factors which have been shown to be indicative of long term chronicity and disability: 1) Negative attitude that back pain is harmful/ severely disabling 2) Fear avoidance behaviour and decreased activity levels 3) An expectation that passive, rather than active treatment, will be beneficial 4) Tendency to depression, low morale and social withdrawal 5) Social or financial problems

Question 34

What does NICE recommend should be used in order to informalities management for chronic back pain?

Answer 34

NICE suggests using the 'STarT Back' risk stratification tool to inform management of patients with chronic back pain.

Question 35

What does the 'STarT Back' tool do?

Answer 35

Stratify's the risk that a patient is at of having persistent disabling symptoms or poor outcomes in relation to back pain.

Question 36

Name 3 things that you should not offer for a person with chronic or disabling back pain.

Answer 36

1) Acupuncture 2) Electrotherapy 3) Orthotics/ traction 4) Spinal injections 5) Disc replacement or spinal fusion (unless part of an RCT).

Question 37

State the 9 factors taken into consideration on the 'STarT Back' risk stratification tool for chronic or disabling back pain.

Answer 37

1) Referred leg pain 2) Co-morbid pain elsewhere 3) Disability (two questions) 4) Fear avoidance 5) Anxiety 6) Catastrophising 7) Depression 8) Overall impact

Question 38

How is the 'STarT back' screening tool interpreted?

Answer 38

- 0-3 = low risk + minimal treatment required - 4 or more on total score = medium risk + physiotherapy required - 4 or more on sub score = high risk + enhanced physiotherapy required

Question 39

Describe the impact of persistent, disabling back pain or amputation on an individual.

Answer 39

1) Withdrawal from activities - 'fear behaviour' 2) May feel stigmatised, especially if others feel they are feigning their illness 3) May lead to psychological sequalae 4) Altered body image in amputation

Question 40

Describe the impact of persistent, disabling back pain or amputation on a patient's family members.

Answer 40

1) Individual becomes increasingly dependent on family (may become burdensome) 2) Role reversal (with children, for example) 3) Reduced income if main bread winner/ self employed

Question 41

Describe the impact of persistent, disabling back pain or amputation on society/ workplaces.

Answer 41

1) Impact is greatest on small businesses who depend heavily on their workforce 2) Back pain is the second most common for long term sickness **Decreased productivity, decreased efficiency, decreased profit, decreased business stability = increased likelihood or redundancies/ closure

Question 42

What is the second most common cause for long term sickness from work in the UK?

Answer 42

Persistent/ chronic back pain.

Question 43

# Define the following types of stigma: 1) Discreditable 2) Discrediting 3) Felt 4) Enacted 5) Courtesy

Answer 43

1) Keeping stigmatising conditions hidden, except to close friends/ family (e.g. HIV) 2) When a stigmatising condition cannot be hidden (e.g. obesity/ acne). 3) Sense of fear and shame projected onto oneself. 4) Acting upon stigma, this discriminating against people 5) Stigma felt by somebody on behalf of another who is susceptible to stigmatisation (e.g. parent of a child with Down's syndrome)

Question 44

Name the 5 types of stigma.

Answer 44

1) Discreditable 2) Discrediting 3) Felt 4) Enacted 5) Courtesy

Question 45

What is internalising with regards to stigma?

Answer 45

When a stigmatised person absorbs the social views of being inferior and the consequences that this has on beliefs and behaviours

Question 46

Give 3 ways that stigma can be non-disclosed.

Answer 46

1) Covering 2) Passing 3) Withdrawal

Question 47

Describe what is meant by the following in terms of reactions to stigma: 1) Covering 2) Passing 3) Withdrawal

Answer 47

1) Concealing the physical thing (e.g. someone bling wearing sunglasses) - can make discrediting stigma discreditable. 2) Concealing discreditable stigma by passing oneself off as normal to others - may still experience felt stigma. 3) Acknowledging symptom, but withdrawing from the normal social world and secluding oneself OR surrounding oneself with others that have a similar issue (support group).

Question 48

1) Describe what is meant by 'resisting' in terms of stigma. 2) Give an example of positive resisting. 3) Give an example of negative resisting. 4) What can resisting provoke?

Answer 48

1) Contesting the stigma related outcomes. 2) A disabled person becoming a Paralympian. 3) Not accepting help as the person does not acknowledge that it is needed. 4) Social change.

Question 49

Give 3 implications of stigma within medicine.

Answer 49

1) Fear of stigma may act as a health-seeking barrier (i.e. doctors judging patients) 2) Concerns about confidentially (who will see records, and will that person stigmatise the patient?) 3) Treatments can lead to stigma (i.e. people using wheelchairs following amputation).

Question 50

Give 4 categories of uncertainty for patients after they have been diagnosed with a long term condition, and give examples.

Answer 50

1) social (employment, finances, relationships) 2) Clinical (varying prognoses, changes between treatments) 3) Uncertainty in the diagnosis itself (i.e. epilepsy) 4) Psycho-social (identity, re-visiting proposed life trajectory)

Question 51

Give 2 different reactions to a patient being diagnosed with a long term condition.

Answer 51

1) Metaphysical questioning - 'why me?' 2) Positive meaning - 'everything happens for a reason' **Note that culture has a big influence on reactions.

Question 52

What is 'biological disruption' with regards to long term conditions?

Answer 52

A disruption to structures of everyday life.

Question 53

Describe 3 aspects of biological disruption in those with long term conditions.

Answer 53

1) Taken for granted assumptions/ behaviour - body can't do certain things anymore. 2) Of biography - self/ identity - re-evaluation of life plans. 3) Response to disruption - demands and resources

Question 54

What is meant by the term 'normal crises' with regards to a patient being diagnosed with a long term condition?

Answer 54

That diagnoses is a continuation/ biographical reinforcement of someone's normal life. For example, a patient may have experienced crises throughout life (poverty, ageing, poor housing), and a diagnosis is just one more thing in the chain, so not a big deal to them. Diagnosis may also be expected (i.e. osteoporosis after life-long hard manual labour/ a complication of a previous disease/ illness).

Question 55

State 2 aspects of further management that may be required for a patient who has a long term illness.

Answer 55

1) Contact with employer - explain circumstances and recommendation (e.g. altered seating/ equipment, adjusted hours with regular short breaks, encourage potential of finding a new role within the organisation). 2) Contact with social services - 'access to work' system works with both patient and employer to find a role that suits the patient.

Question 56

Aside from the 'access to work' system, state 3 other methods of help that social services can offer to patients.

Answer 56

1) Help to find alternative work 2) Help accessing disability benefits 3) Help o find housing suitable for needs 4) Help to pay for transport costs.

Question 57

Define the term 'guidelines'.

Answer 57

Systematically developed statements to assist practitioner and patient decisions regarding appropriate healthcare for specific clinical circumstances.

Question 58

Give 3 benefits of the development of clinical guidelines.

Answer 58

1) Enable consistent care across the country (decrease practice variance). Bridge 2) Bridge the gap between what evidence recommends and the reality of clinical treatment. 3) Indicate useful and cost-effective intervention/ investigations 4) Adherence to guidelines has been shown to significantly increase positive outcomes. **Note that guidelines should assist and not dictate.

Question 59

Give 3 reasons why guidelines might not be adhered to.

Answer 59

1) Lack of knowledge of the guideline. 2) Conflicting guidelines for patients with multiple morbidities. 3) Rapidly developing areas of treatment.

Question 60

Give 2 limitations of guidelines.

Answer 60

1) Need be applied in the context of individual patients - they are not the final word on investigation and management. 2) May endorse the use of technology which is unavailable locally - this means that it may be difficult to implement guidance.

Question 61

State 5 methods of health promotion with regards to reducing incidents involving burns and scalds.

Answer 61

1) Fire alarm testing/ houses encouraged to regularly check fire alarms 2) Electrical PAT registration 3) Chip pan fire awareness scheme 4) Bonfire night ad campaigns 5) Building regulations 6) Public area health and safety regulations (fire extinguishers, fire exits, fire retardant materials) 7) Dedicated fire safety wardens in public places and schools 8) Regular fire drills 9) Fire safety training 10) Fire alarms in public buildings 11) Charities (i.e. Red Cross) raising awareness of how to treat burns 12) Having kettles and hot appliances away from edge of kitchen top

Question 62

State 4 major complications of joint replacement surgery.

Answer 62

1) Clotting > DVT > PE 2) Wound haematoma 3) Infection 4) Nerve injury

Question 63

What are the 4 main categories of aids to daily living that are available?

Answer 63

1) Mobility 2) Feeding 3) Dressing 4) Other

Question 64

Give examples within the following categories of aids to daily living that are available: 1) Mobility 2) Feeding 3) Dressing 4) Other

Answer 64

1) grab rails, crutches, ramps, walking frames, toilet frames, commodes, hoists, stair lifts. 2) adapted ergonomic cutlery, beakers, easy-use jar/ bottle/ tin openers 3) Shoehorns, stocking aids 4) Lighting, magnifiers, phones with large buttons

Question 65

Give 3 longer term functional or socioeconomic consequences of upper limb trauma.

Answer 65

1) Chronic problems - weakness, spasticity - may cause trouble with ADLs. 2) Reliance on upper limbs for working - may need adaptions, become unemployed or need to take time off work. 3) Lack of or dysfunction of upper limb may affect relationships. 4) More difficult to play with and help with young children

Question 66

Briefly outline the main roles of occupational therapists in those with chronic pain.

Answer 66

1) Help individuals adapt to their life with chronic pain: - Increase independence - Increase confidence and control 2) Do ADL assessment (i.e. Barthel index) to inform necessary level of care 3) Home adaptations, work adaptations 4) Help with leisure and social activities.

Question 67

Briefly outline the main roles of physiotherapists.

Answer 67

- Assist in rehab, providing individual plans tailored to the need of the patient. - Exercises and manoeuvres to increase function and minimise impact of condition.

Question 68

Describe the role of complementary and alternative medicines in back pain.

Answer 68

There is limited evidence. NICE explicitly does not recommend some CAMs for back pain, for example, acupuncture.

Question 69

State 4 potential adverse effects of complementary and alternative medicine approaches.

Answer 69

1) Allergy - sensitising capacity of numerous herbal remedies. 2) Mechanical injury - acupuncture leading to pneumothorax, cardiac tamponade or spinal injury or chiropractor practice leading to spinal cord injury. 3) Infection - after acupuncture. 4) Nutrition - severe deficiencies result in those given strict alternative diets.

Question 70

Give the 3 instances where NICE does recommend CAMs.

Answer 70

1) Alexander technique for PD. 2) Ginger and acupressure for morning sickness. 3) Manual therapy for lower back pain.

Question 71

What is a major consideration to undertake when thinking about seeking help within CAM?

Answer 71

Are practitioners qualified, registered, audited and revalidated by a responsible/independent national accrediting body?

Question 72

What is the main negative perception about those who offer CAMs?

Answer 72

That they are preying on the vulnerable who are desperate for solutions to problems that conventional western medicine has failed to answer.

Question 73

Describe the relationship between placebos and CAMs.

Answer 73

There are few CAM trials that exist which demonstrate that the CAM is more effective than the placebo.

Question 74

What forms the basis of chiropractic?

Answer 74

Manual adjustments of spine and joints to relieve MSK mechanical disorders and nervous system disorders.

Question 75

What forms the basis of osteopathy?

Answer 75

Touch, physical manipulation and stretching to increase mobility and blood flow to relieve spasms.

Question 76

Define the term 'medical unexplained symptoms'.

Answer 76

Physical symptoms with no organic disease explanation, assumed to be caused by psychological factors. They often arise from normal body physiology or minor existing pathology but are exaggerated by stress and often misinterpreted.

Question 77

1) What percentage of primary care symptoms are MUS? | 2) What percentage of secondary care symptoms are MUS?

Answer 77

1) 25% | 2) 40-50%

Question 78

1) Name 2 direct mechanisms of stress causing MUS. | 2) Name 3 indirect mechanisms of stress causing MUS.

Answer 78

1) Sympathetic adrenal-medullar axis and HPA axis. | 2) Stress causing poor medication compliance, increased maladaptive coping, decreased exercise.

Question 79

State 2 ways in which stress can lead to the presentation of MUS.

Answer 79

1) Chronic stress = up regulation HPA axis = pathology (i.e. stress myocardiopathy/ broken heart syndrome). 2) Stress due to a significant life event (a major aetiological factor in mental health).

Question 80

Response to illness is dependent on what?

Answer 80

Several individual and illness specific factors.

Question 81

State 3 individual factors that can influence a patient's response to illness.

Answer 81

1) Premorbid personality (worrier) 2) Prior experience of that illness 3) Pre-existing mental state illness 4) Childhood experiences (core beliefs) **All affect appraisal style + resultant response.

Question 82

State 3 illness-specific factors that can influence a patient's response to illness

Answer 82

1) Immediacy – life threatening? 2) Uncontrollability – XS pain 3) Ambiguity/’not-knowing’ re: prognosis 4) Undesirability of treatment regimens or disfiguring treatments (i.e. mastectomy)

Question 83

Describe what is meant by the term 'Levanthal cognitions'.

Answer 83

Patient's own implicit beliefs regarding the illness.

Question 84

Name the 5 cognitive categories which can influence a patient's beliefs about illness, according to the 'Levanthal's cognitions' framework, and give examples of considerations within these categories.

Answer 84

1) ID – what is it? 2) Timeline – perceived duration? Life-long or acute? 3) Consequence – expected outcome: bleeding? Loss of function? Death? 4) Cause – Pt personal ideas: ‘catch it from someone’? Result of lifestyle? God punishing them? 5) Control – how pt can control it/recover

Question 85

Name and describe the 2 main coping strategies?

Answer 85

1) Problem solving - seeking information, taking control, reconstructing the illness be manageable and developing realistic plans/ goals. 2) Emotion focused - talking about the problem, using supportive friendships, seeking religious support.

Question 86

In basic terms, how does a patient decide which coping strategy to use?

Answer 86

Interpret the illness using Levanthal's cognitions > select coping strategy > appraise coping strategy. **This tends to work transiently though, and patient care encouraged to use both strategies.

Question 87

What is the difference between the terms 'illness and disease'?

Answer 87

Illness is the subjective experience of a pathology (symptoms), where as disease is a pathological process in the body.

Question 88

What are the 4 most common types of MUS?

Answer 88

1) Chest pain 2) Chronic fatigue 3) Headaches 4) Muscle/ joint pain

Question 89

Why can MUS prove to be problematic?

Answer 89

Symptoms + no disease present means that patient needs are not met and there is increased risk of iatrogenic harm. Doctors can become frustrated at the lack of diagnosis. There is inefficient use of resources.

Question 90

State 3 assumptions that doctors make about patients with MUS.

Answer 90

1) Explanation for MUS lies within the patient. 2) Half of patients deny psychological cause/ somatisation of psychological distress 3) They seek cure and diagnosis 4) They get physical intervention because they demand it (it is easier to give in than to argue) 5) To avoid physical intervention, doctors should help patients to appreciate psychological factors.

Question 91

State 3 things that patients actually want with regards to their MUS.

Answer 91

1) Alliance - with the doctor (shared problem - both in same boat) 2) Exculpation - realise reality from their suffering and confirm it isn't the patient's fault (clear them of blame) 3) Convincing explanation - that seems plausible to the patient

Question 92

What are the 3 main explanations that patients tend to receive to explain MUS?

Answer 92

1) Rejecting 2) Colluding 3) Empowering

Question 93

What is meant by the 'rejecting' explanation of MUS?

Answer 93

Denial of the reality of the symptom and the implication that it is imaging (causes stigma, an unresolved problem and distrust in the doctor).

Question 94

What is meant by the 'colluding' explanation of MUS?

Answer 94

Sanctioning the patient's beliefs because it is easier - leads to questioning of the doctors integrity, openness and competence (?FTP)

Question 95

What is meant by the 'empowering' explanation of MUS?

Answer 95

Offering a tangible mechanism, exculpation ad opportunities for self-management. This legitimises the patient's suffering, gives the patient 'ownership' of explanation, removes blame and forms an alliance between the doctor and patient. This encourages a continuing and healthy professional relationship and concordance.

Question 96

What is the main reason for carrying out qualitative research for patients with MUS?

Answer 96

To gather data on experiences, views and opinions via interviews, focus groups and documents.

Question 97

What does qualitative research generate in regards to MUS?

Answer 97

Subjective data on personal experiences of symptoms.

Question 98

How is qualitative data analysed with regards to MUS?

Answer 98

For themes (thematic analysis) in order to identify key ideas and patterns.

Question 99

State and describe 3 of the main themes discovered when analysing qualitative research from MUS patients.

Answer 99

1) Lives become socially precarious (strained relationships with family and friends) 2) Uncertainty with regards to diagnsis/ prognosis (impacts on future planning = biological disruption) 3) Lack of legitimacy (can't enter sick role, can't access support groups, social isolation) 4) Questioning self and identity (blame themselves, guilt of being a fraud/ time-waster).