Case Study Answers Flashcards
Lisa comes to see you in the early stages of pregnancy. She wonders
whether she should keep the baby or not. List three ETHICAL issues that she may be considering
Beliefs regarding termination
Any religious beliefs
Thoughts regarding bringing a child into the world that you do not fell able to care for.
Lisa comes to see you in the early stages of pregnancy. She wonders
whether she should keep the baby or not. List three PSYCHOLOGICAL issues that she may be considering
Anxiety about being a parent
Anxiety about going through with a termination
Stress/anxiety about level of support she may have from family and friends
Lisa comes to see you in the early stages of pregnancy. She wonders
whether she should keep the baby or not. List three SOCIAL issues she may be considering.
Support network - does Lisa feel her friends would be supportive
Her social life will dramatically change after having a baby
Ability to find work will be affected in the short and/or longer term.
What factors might increase the chance of someone changing their
behaviour? (5)
You think the advantages of change outweigh the disadvantages
You anticipate a positive response from others to your behaviour change
There is social pressure for you to change
You perceive the new behaviour to be consistent with your self-image
You believe you are able to carry out the new behaviour in a range of
circumstances
Give four possible benefits of adopting the mutual participation style of consultation
Greater participation by the patient means they have a feeling of relatively
greater personal autonomy
The patient adopts greater responsibility for their own health through sharing
of information and decision making
Patients are generally more satisfied with consultations where they have
been fully informed and are therefore less likely to complain about their care
May increase compliance with advice/concordance with treatment
Other than mutual participation give two styles of doctor patient relationship and give a brief description of each.
Authoritarian or paternalistic relationship: the physician uses all of the
authority inherent in his/her status and the patient has no autonomy. The
patient tries hard to please the doctor and has does not actively participate in
their own treatment.
Guidance/co-operation relationship: the physician still exercises much
authority and the patient is obedient, but has a greater feeling of autonomy
and participates somewhat more actively in the relationship.
Give a brief description of: Content skills, perceptual skills, and process skills.
Content skills: what doctors communicate-the substance of their questions
and responses, the information they gather and give; the treatments.
Perceptual skills: what they are thinking and feeling-their internal decision
making, clinical reasoning; their awareness of their own biases, attitudes and
distractions.
Process skills: how they do it-the way doctors communicate with patients;
how they go about discovering the history or providing information; the verbal
and non-verbal skills they use; the way they structure and organise
communication.
What kind of actions might a government take to promote health in the population as a whole?
Legislation/policies on smoking/alcohol (e.g. minimum age to buy products, licensing laws, taxation) Improvements in housing Provision of health education Health and safety laws Traffic/transport legislation/policies
What is the WHO definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
Using the WHO definition give six reasons why Lisa might feel she is healthy
She has no illness/ long term condition (chronic disease) She exercises regularly She is on no regular medication She manages to work, socialise ‘Healthy diet’ She managed to become pregnant
List four factors which influence lay beliefs about health
Age
Social Class
Gender
Culture
Lisa thinks that smoking is normal behaviour. Why might she feel this way? (2)
It may be normal for her peer group but would be abnormal perhaps for the wider population and/or a different population.
She may watch TV programmes where smoking is normal behaviour.
List 4 different HCPs that may be involved in Lisa’s + baby’s postnatal care and describe their role.
GP: postnatal examination of Lisa, 8 week baby check, advice on immunisations, care of any medical problems.
Midwife - follow up of Lisa and baby for first 10 days after birth, advice on feeding
Health visitor: advice on early child care from day 10 to school age, immunisations
Pharmacist: advice on and supply of OTC drugs, minor ailments, smoking cessation.
When Kayleigh is 3 months old, Lisa brings her to the surgery with a 3 day
history of diarrhoea and fever. You use hypothetico-deductive reasoning and
diagnose viral gastro-enteritis (a simple “tummy bug”/infective diarrhoea).
Describe how you might use the hypothetico-deductive reasoning process to
make this diagnosis.
The patient history leads to making several diagnostic hypotheses, based on
your past experience e.g. simple infective diarrhoea, infection elsewhere such
as a respiratory infection, malabsorption syndrome or acute appendicitis.
Rare, but not immediately concerning diagnoses can be excluded at this
stage e.g. malabsorption syndrome, as although important, it is not
immediately life threatening.
Acute appendicitis is also rare, but is life threatening, so needs to be actively
excluded.
Strengthen the case for diagnoses/diagnosis through more detailed history
and examination and possibly some initial investigations. This may help
provide evidence for your initial hypotheses, but if not…
Extend the search if no diagnosis identified.
Hypothetico-deductive reasoning is not necessarily about common
diagnoses, but about likely diagnoses.
If the patient does not follow the expected pattern of illness/recovery from the
postulated diagnosis, revision of the diagnosis is required e.g. persistent
diarrhoea may then make a diagnosis of malabsorption more likely and this
will need to be investigated.
What would safety netting advice include?
Advise patient of expected course of the illness
Advise symptoms that would indicate deterioration
Advise who to contact if deterioration occurs
