Chapter 1 Flashcards
What are the 5 criteria for patient-centered care?
- Explores patients’ main reason for visits, concerns and need for info
- Seek an integrated understanding of patients world
- Finds common ground and mutually agrees on management
- Enhances prevention and health promotion
- Enhances continuing relationship between pt and dr
- Is realistic
What is the doctor expected to do in the sick role?
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
What is the patient expected to do in the sick role?
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
Why is evidence based decision making important?
Medical knowledge is incomplete
Medical facts are ever expanding
Medical knowledge is constantly shifting
Constant need for innovation and improvement
What is the regulatory role of the GMC?
To protect, promote and maintain health and safety of the public by ensuring proper standards in the practice of medicine
What is meta ethics?
Study of meaning of moral concepts, what is right and wrong
What is normative ethics? (Moral theory)
Study of the way of deciding what is the right action
What is applied ethics?
The application of moral theory and principles to actual causes
What is consequentialism? (Moral theory)
Rightness of action determined by desirability of consequence e.g. Utilitarianism maximises utility (pleasure, economy, lack of suffering)
What is deontology (moral theory)?
The act is right if it accord with a system of rules or duties - may eh right even if it leads to bad consequences
What is virtue ethics? (Moral theory)
Right action is the one that a virtuous person would perform in the circumstances e.g. Compassion
What are the four ethical principles?
- Autonomy- respect right to make decision
- Non-maleficence- do no harm
- Beneficence- always act to benefit patients
- Justice- treat all fairly and equally
What is the difference between disease and illness?
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
What is paternalism?
Interference with a persons freedom of action of info, justified by reasons referring to welfare of person.
Only acceptable when treating infants and children
Define epidemiology
Study of distribution and determinants of health related states and events in populations and the application of this study to control health problems
Incidence vs prevalence
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
What is the symptom iceberg?
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
What are the barriers to seeking help?
Disruption of work Lack of transport Unable to travel distances Bad previous experience Psychological - do not believe they have condition
Define medical pluralism
Co-existence with a society of differentials designed and conceived medical traditions and systems
What triggers a visit to the doctor?
Interference with work or physical activity Interference with social relations Interpersonal crisis Putting a time limit of symptoms Sanctioning
What are the 4 approaches to health promotion?
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
What are the 3 stages of prevention?
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
Examples of what is meant by social inequalities in health?
Manual workers have a much higher incidence of infant mortality
Teenage pregnancy is more common amongst lower social groups
How can inequality be measured?
Gini coefficient
Ration between Lorenz curve and a straight line is the Gino coefficient
What are explanations for social inequalities in health?
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
What is the wilkinson hypothesis?
Inequality generates ill health
What is consent?
A properly informed decision of a competent patient, freely given. Can be oral, written, expressed or implied
What is Tillich competence?
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
What is a hull hypothesis?
A hypothesis that there is no difference between 2 groups. A P value can be calculated- smaller it is the stronger the null hypothesis
Define risk
Probability that an event will occur during a specified time
What is the difference between relative and absolute risk?
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
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
Cohort study (also longitudinal or follow-up study)
How many people in the uk donate blood?
2 million per year
Reasons for and against a market for blood
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
What is an impairment?
Temporary or permanent loss of abnormality of a body structure or function. Disturbance affecting functions
What is a disability?
Restriction or lack of ability to perform an activity in the normal range resulting from impairment
What is a handicap?
Disadvantage for an individual, resulting in an impairment that limits the fulfilment of a normal role
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?
Disability discrimination act 1995
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?
Equality act 2010
