Chapter 1

Question 1

What are the 5 criteria for patient-centered care?

Answer 1

1. Explores patients’ main reason for visits, concerns and need for info
2. Seek an integrated understanding of patients world
3. Finds common ground and mutually agrees on management
4. Enhances prevention and health promotion
5. Enhances continuing relationship between pt and dr
6. Is realistic

Question 2

What is the doctor expected to do in the sick role?

Answer 2

Apply high degree of skill and knowledge
Act for welfare of patient and community, not self interest
Be objective and emotionally detached
Be guided by rules of professional practice

Question 3

What is the patient expected to do in the sick role?

Answer 3

Want to get well as quickly as possible
Seek medical advice and cooperate with doctor
Allowed to shed normal activities and responsibilities
Regarded in need of care and unable to get better on their own

Question 4

Why is evidence based decision making important?

Answer 4

Medical knowledge is incomplete
Medical facts are ever expanding
Medical knowledge is constantly shifting
Constant need for innovation and improvement

Question 5

What is the regulatory role of the GMC?

Answer 5

To protect, promote and maintain health and safety of the public by ensuring proper standards in the practice of medicine

Question 6

What is meta ethics?

Answer 6

Study of meaning of moral concepts, what is right and wrong

Question 7

What is normative ethics? (Moral theory)

Answer 7

Study of the way of deciding what is the right action

Question 8

What is applied ethics?

Answer 8

The application of moral theory and principles to actual causes

Question 9

What is consequentialism? (Moral theory)

Answer 9

Rightness of action determined by desirability of consequence e.g. Utilitarianism maximises utility (pleasure, economy, lack of suffering)

Question 10

What is deontology (moral theory)?

Answer 10

The act is right if it accord with a system of rules or duties - may eh right even if it leads to bad consequences

Question 11

What is virtue ethics? (Moral theory)

Answer 11

Right action is the one that a virtuous person would perform in the circumstances e.g. Compassion

Question 12

What are the four ethical principles?

Answer 12

1. Autonomy- respect right to make decision
2. Non-maleficence- do no harm
3. Beneficence- always act to benefit patients
4. Justice- treat all fairly and equally

Question 13

What is the difference between disease and illness?

Answer 13

Disease- broken part of body, symptoms, abnormal tests- treat condition

Illness- unique personal experience, ICEF, social aspect- enhances relationship, discover how affects life as whole

Question 14

What is paternalism?

Answer 14

Interference with a persons freedom of action of info, justified by reasons referring to welfare of person.
Only acceptable when treating infants and children

Question 15

Define epidemiology

Answer 15

Study of distribution and determinants of health related states and events in populations and the application of this study to control health problems

Question 16

Incidence vs prevalence

Answer 16

Incidence- no of new cases of disease in period/ initially free from disease

Prevalence- no of people with the disease at a particular point in time/ total population

Question 17

What is the symptom iceberg?

Answer 17

Most symptoms do not trigger a visit to the doctor
Most health care work is done by lay people
Only 1/3 of symptoms lead to a professional consultation

Question 18

What are the barriers to seeking help?

Answer 18

Disruption of work
Lack of transport
Unable to travel distances
Bad previous experience
Psychological - do not believe they have condition

Question 19

Define medical pluralism

Answer 19

Co-existence with a society of differentials designed and conceived medical traditions and systems

Question 20

What triggers a visit to the doctor?

Answer 20

Interference with work or physical activity
Interference with social relations
Interpersonal crisis
Putting a time limit of symptoms
Sanctioning

Question 21

What are the 4 approaches to health promotion?

Answer 21

Medical- focus on disease and prevention
Behavioural- focus on attitudes and lifestyles
Client-centred- focus on empowering individuals
Societal- focus on political and social action

Question 22

What are the 3 stages of prevention?

Answer 22

Primary prevention- screening risk factors, health promotion and education
Secondary prevention- detect and cute disease at an early stage e.g. Cancer screening
Tertiary care- minimise effects or reduce the progression of irreversible disease e.g. False teeth, hip replacement, palliative care

Question 23

Examples of what is meant by social inequalities in health?

Answer 23

Manual workers have a much higher incidence of infant mortality
Teenage pregnancy is more common amongst lower social groups

Question 24

How can inequality be measured?

Answer 24

Gini coefficient

Ration between Lorenz curve and a straight line is the Gino coefficient

Question 25

What are explanations for social inequalities in health?

Answer 25

Black report suggests problems are structural. Natural/social selection- richer are healthier, choose healthier partners, healthier offspring.
Materialist idea- poverty causes ill health through diet, environment
Cultural

Question 26

What is the wilkinson hypothesis?

Answer 26

Inequality generates ill health

Question 27

What is consent?

Answer 27

A properly informed decision of a competent patient, freely given. Can be oral, written, expressed or implied

Question 28

What is Tillich competence?

Answer 28

Parental right yields to the child’s right to make their own decisions when they reach a sufficient understanding and intelligence to be capable of making up their own mindn

Question 29

What is a hull hypothesis?

Answer 29

A hypothesis that there is no difference between 2 groups. A P value can be calculated- smaller it is the stronger the null hypothesis

Question 30

Define risk

Answer 30

Probability that an event will occur during a specified time

Question 31

What is the difference between relative and absolute risk?

Answer 31

Relative- probability of developing, in a specific period, an outcome among those receiving the treatment of interest or exposed to a risk factor, compared with probability of developing outcome if risk factor is not present
Absolute- observed or calculated probability of an event

Question 32

What is the name for an epidemiological study whereby a defined subset of the population can be identified and classified according to exposure status. Main feature- can determine incidence rate of disease amongst exposed and unexposed individuals

Answer 32

Cohort study (also longitudinal or follow-up study)

Question 33

How many people in the uk donate blood?

Answer 33

2 million per year

Question 34

Reasons for and against a market for blood

Answer 34

Against- increased supply from poor, unemployed may increase infection
Represses altruism and sense of community
For- increase supply by removing obstacles from donors
Offer financial rewards to improve donation

Question 35

What is an impairment?

Answer 35

Temporary or permanent loss of abnormality of a body structure or function. Disturbance affecting functions

Question 36

What is a disability?

Answer 36

Restriction or lack of ability to perform an activity in the normal range resulting from impairment

Question 37

What is a handicap?

Answer 37

Disadvantage for an individual, resulting in an impairment that limits the fulfilment of a normal role

Question 38

What act gives new rights to people who have had a disability which makes it difficult for them to carry out day to day activities?

Answer 38

Disability discrimination act 1995

Question 39

What act states that you are disabled if you have a physical or mental impairment that has a substantial and long term negative effect on your ability to do normal activities?

Answer 39

Equality act 2010