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Medicine year 1 semester 2 > Case 9- domestic abuse and empathy > Flashcards

Case 9- domestic abuse and empathy Flashcards

1
Q

Domestic abuse

A

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality

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2
Q

Types of domestic abuse

A

Psychological, emotional, physical, sexual, honour based violence, female genital mutilation and financial

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3
Q

Define controlling behaviour

A

A range of acts designed to make the person subordinate and/or dependent by

  • isolating them from sources of support
  • depriving them of means needed for independence, resistance and escape
  • exploiting their resources/capacities for personal gain
  • regulating their every day behaviour
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4
Q

Define coercive behaviour

A

An act or pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish or frighten the victim

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5
Q

Risk factors for domestic abuse

A

Females, young age, learning disability, mental health issues, power imbalance, controlling behaviour, pregnancy, sexuality

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6
Q

Why is domestic abuse hard to spot

A

1) Evolves- not immediate
2) Manipulation
3) Shame/embarrassment
4) Fear of getting it wrong
5) Charm offensive (cycle of abuse)

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7
Q

The cycle of abuse

A

Calm - incident is forgotten, no abuse taking place, honeymoon period
Tension building - breakdown of communication, victim becomes fearful and tries to placate the abuser
Incident - verbal, emotional or physical abuse, anger, blaming, arguing, threats
Reconciliation - abuser apologises and gives excuses, blames victim or denies abuse

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8
Q

Biological impact of domestic abuse

A
  • cuts, scars, wounds, bruises, fractures
  • STIs and unwanted pregnancy
  • non specific symptoms - headaches, fainting, churning pain
  • self neglect
  • homicide
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9
Q

Psychological impact of domestic abuse

A
  • emotional distress
  • depression, anxiety, suicidility, self harm, PTSD
  • alcohol/substance abuse
  • eating disorders
  • sleep disorders
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10
Q

Social impact of domestic abuse

A
  • financial dependence on partner
  • impact on work
  • homelessness
  • drink/drug behaviours
  • isolation from friends and family
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11
Q

What medical help do survivors of abuse need

A

More visits to doctors
More operative surgery
More hospital stays
More mental health consultations

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12
Q

What to do if a patient discloses domestic abuse

A 
Believing not blaming
Treating health consequences
Supporting
Documenting
Following up
Identifying and managing risks
Safeguarding role
Signposting
Safety planning - exit plans
Share concerns - safeguarding, social services
DON'T IGNORE IT
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13
Q

When should domestic abuse be referred to safeguarding

A

Children involved
Risk of serious crime
Vulnerable person

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14
Q

Why is it hard for the victim to leave

A 
Fear of criminal action
Fear of loss of children
Family breakdown
Financially trapped
Homelessness
Stigma
Embarrassed
Still love the perpetrator
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15
Q

Emotional and financial abuse

A

Emotional- name calling, undermining, ignoring, belittling them
Financial- small allowance, no money of their own, aren’t allowed to get a job

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16
Q

Sexual abuse

A

Rape, forced to watch pornography, taking inappropriate photos and then sharing them.

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17
Q

Empathy

A

The capacity to understand the patients situation, perspective and feelings and to communicate that understanding back to the patient

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18
Q

Difference between sympathy and empathy

A

Empathy is understanding why another person is suffering and being able to put yourself in their shoes. Sympathy is natural response to someone else suffering, feeling of pity or concern seen from an external perspective

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19
Q

Benefits of empathy

A

Enhances the doctor-patient relationship
Increases patient and doctor satisfaction
Improves diagnostic accuracy
Reduces anxiety and depression in cancer patients
Linked with quality of life and well being measures
Increases concordance with treatment plans

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20
Q

Consequences of lack of empathy

A

Patient feels unacknowledged and unheard
Doctor feels unappreciated
Ineffective consultation
Inaccurate diagnoses

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21
Q

Components of empathy

A

Emotive - emotional intelligence to recognise the patients emotions (seeing an emotion)
Cognitive - accurately appreciate and understand the patients feelings
Moral - altruism, choosing to respond
Behavioural - sensitively and effectively communicating that understanding back to the patient, verbally and non verbally

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22
Q

What facilitates empathy

A

1) Listening and empathy - non verbal communication and responding to cues
2) Continual human connection - successful opening of interview, open questions and giving patients time. Mirroring, professional appearance and appropriate physical contact
3) Information flow from the patient - show interest in the patient and use of silence. Don’t interrupt, be dismissive or make assumptions

23
Q

How can you display empathy?

A 
Verbal
Facial expression
Eye contact
Body posture
Gesture
Tone of voice
Use of silence
Immersion and interest
Use of touch
24
Q

Types of touch in empathy

A

Procedural touch - physical contact that occurs during a task (eg greeting, examination or helping on/off couch)
Expressive touch - spontaneous contact which is not required as part of task or examination

25
Q

What factors influences the use of touch in a consultation

A

Age of patient, gender of doctor and patient, level of distress, clinical context and personality. Generally touch on the hand or forearm is accepted

26
Q

Skills for developing rapport with patient

A
  • Acceptance- accepts legitimacy of patients views and feelings, is non-judgemental.
  • Empathy- uses empathy to communicate understanding and appreciation of the patients feelings. Overtly acknowledge patients views and feelings
  • Support- express concern, understanding, willingness to help. Acknowledge coping effort and appropriate self care
  • Sensitivity- deal sensitively with embarrassing and disturbing topics and physical pain.
27
Q

How to respond to a patients emotion

A

First you recognise the emotions or feelings from their cues. You then respond to the emotion in some way, you acknowledge the emotion, invite further exploration as appropriate and using a non-verbal and verbal empathic response.

28
Q

Newsreader effect

A

Changing your posture, expression and tone of voice to suit the mood of the session

29
Q

Mental health

A

A state of wellbeing in which an individual realises their ability, can cope with the normal stresses of life, can work productively and is able to contribute to their community.

30
Q

Attitudes of society to those with mental health issues

A
  • Public is more accepting of a person with depression than they are with schizophrenia
  • Public less willing to interact with someone with a mental illness in a personal setting (marrying into family or providing child care)
  • Majority think an employee with depression is less likely to be promoted
  • Negative stigma with mental illness, stereotyped views so people may be subject to discrimination
  • Stereotype that someone with a mental illness is dangerous/violent and unable to live a normal life
31
Q

Vulnerability factors affecting mental health

A 
Psychological- genetic, resilience
Personality- low self esteem
Social adversity- housing, poverty
Family- parental loss, child abuse
Social reasons- few social contacts
32
Q

Protective factors concerning mental health

A

Good parenting
Happy relationship
High self esteem

33
Q

Diagnosing a mental illness

A

Largely based on history taking
Symptoms very subjective and individual - they vary depending on situation
Limited investigations to diagnose
Requires clinical judgement - interpret symptoms in the context of that individual
Comprehensive biopsychosocial assessment

34
Q

Biological vulnerability to mental health issues

A

Biogenetic risk factors= genetic factors, temperamental predisposition, gender
Psychological risk factors= early and recurrent trauma, poor coping styles

35
Q

Psychological vulnerability to mental health issues

A

Somatic risk factors= somatic disease, substance misuse,

Social and cultural risk factors= instability, environmental factors

36
Q

The cycle of stigma

A

1) Stigma
2) Negative perception of mental illness
3) Fear of discrimination
4) Avoidance of help and recourses
5) Untreated mental illness, perpetuating misconceptions

37
Q

Trigger for mental health issues

A

People may have a disproportionate response to a life event, like a break up. Can be not having a big enough response ie to death.

38
Q

Most common mental health disorder in the UK

A

Mixed anxiety and depression

39
Q

How mental health issues may present to the doctor

A

Women are more likely to present than men, can be direct or indirect. May present with low mood, insomnia, weight loss and irritability. Can be hand on door.

40
Q

Physical manifestations of depression

A

Lethargy, poor sleep, loss of appetite, poor libido

41
Q

Physical manifestations of anxiety

A

Palpitations, chest pain, breathlessness, sweating, dizziness and diarrhoea

42
Q

Somatic symptoms

A

An illness where emotional factors produce physical symptoms. For example, abdomen pain, headache and dizziness. Underlying anxiety and mood drives exacerbations. It is challenging to explain and treat.

43
Q

What other specialities does mental health overlap with

A

Neurology (epilepsy), chronic pain clinics and obstetrics (post-natal depression)

44
Q

Self help recourses for mental health

A

Online forums
Mood gym
Self guided CBT online
Self referred for counsellor by GP

45
Q

Cognitive behavioural therapy

A 
Talking therapy which helps you manage your problems by changing the way which you think and behave
Breaks problems into smaller parts
Stop negative thought cycle
Often used alongside SSRIs
Key non pharmacological intervention
46
Q

Other psychological therapies

A 
RELATE - relationship therapy
Family therapy
DBT and MBT
Anger management
Art therapy
Music therapy
Bereavement counselling
EMDR (eye movement desensitisation and reprocessing)
47
Q

Social support to help mental health

A 
Financial services
Employment services
Housing services
Social care and social workers
Safeguarding team
48
Q

Stepped-care model; Step 1

A

Assessment, support, psychoeducation, referral

49
Q

Stepped-care model: Step 2 (Persistent symptoms; mild-moderate)

A

Low intensity psychosocial, psychological interventions, medication, referral

50
Q

Stepped care model: Step 3 (moderate to severe)

A

Medication, high intensity psychology, combined treatment, referral

51
Q

Stepped care model: Step 4 (severe and complex, risk to life)

A

Medication, high intensity psychology, combined, ECT, crisis, MDT, inpatient care

52
Q

Patient self care

A

Reducing caffeine, weekly Pilates, listening to music to de-stress, meeting up with friends and giving up smoking.

53
Q

How does empathy lead to better clinical outcomes

A

1) Improves patient satisfaction and concordance with treatment
2) Patients feel less anxious with an empathetic doctor
3) The patient is more likely to trust the doctor and reveal more information, this improves diagnostic accuracy and prediction of treatment pitfalls
4) Patients are more likely to make a positive lifestyle choice

Medicine year 1 semester 2 (61 decks)

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