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Crash Course Flashcards

1
Q

What are the ethical pillars?

A

Non-Maleficence - Cause as little harm as possiple to patient or staff
Beneficence - Act in what you believe is the best decision for the patient
Autonomy - Respect the patient’s decision
Justice - Don’t discriminate/waste resources

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2
Q

What is consent?

A

Consent means a voluntary, un-coerced decision made by a sufficiently competent or autonomous person on the basis of adequate information and deliberation, to accept rather than reject some proposed course of action

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3
Q

What must you have for valid consent?

A

They must be informed
They must be uncoerced
They must be compitent

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4
Q

What are the requirements for the mental capacity act 2005?

A
  1. Patient must understand
  2. Retain information
  3. Weigh up information
  4. Communicate their decision
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5
Q

How can a doctor avoid battery charges?

A

By making the patient aware of any risks of the procedure

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6
Q

What is the importance of consent?

A
  • It’s a legal requirement
  • Respects patient’s autonomy
  • Establishes releationship of trust with the patient
  • It benefits the patient in multiple ways:
    1) It allows for them to have more releastic expections and gives them the feeling of control
    2) It allows for greater co-operation
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7
Q

What must a doctor do if a patient is refusing life saving treatment?

A

He must asses the patients competence and ensure the patient is giving VALID consent

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8
Q

Does a patient have the ability to refuse life saving treatment?

A

If they are competent and have valid consent then yes

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9
Q

When is consent not needed?

A
  • Necessity: Where treatment is best option and patient is NOT COMPETENT to give consent
  • Emergency: Dr must act (e.g. ambulance brings patient -> hospital in A&E) to prevent harm
  • Children and when patients pose risk to others (TB)
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10
Q

What must be considered when making a practical decision?

A

•Moral Perception – consider ethical dimensions which may not be apparent at first sight • Moral Reasoning – The 4 principles:
- Autonomy – respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices (TRUTH/CONSENT/CONFIDENTIALITY)
- Beneficence – this considers the balancing of benefits of treatment against the risks and costs; HCP should act in a way that benefits the patient
- Non-maleficence –avoiding the causation of harm; the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment
- Justice – distributing benefits, risks and costs fairly; the notion that patients in similar positions should be treated in a similar manner
•Moral Action – actually implementing the ethical practice independently (should do  must do)

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11
Q

What attributes should a HCP have?

A
  • Belong to an organisation (NHS)
  • Exercise autonomy over their work
  • Pledge assistance to those in need
  • Possess ‘esoteric’ knowledge – deep knowledge understood by few
  • Licensed by state
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12
Q

What are the duties of a HCP?

A
  • Moral duty – is it the correct ethical expression? (guilty)
  • Professional duty – what does the regulatory body say (GMC)? (sacked)
  • Legal duty – is it within the boundaries of the law? (jailed)
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13
Q

What models must be taken into consideration when treating a patient?

A

Consider the bio-psycho-social model when interviewing patients with a chronic illness or a disability as this may be a particularly relevant to their condition/lifestyle.
Also consider patient-orientated care e.g. GP, district nurse, family/carer etc. – Primary Care Team

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14
Q

What is stigma?

A

A dynamic process of devaluation that discredits an individual in eyes of others

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15
Q

What is discrimination?

A

Having +ve/-ve actions towards someone

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16
Q

What is ignorance?

A

Having slanted views on X people

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17
Q

What is prejudice?

A

A +ve/-ve attitude towards someone

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18
Q

What are the types of mental illness?

A

Orginc - Where there is a physiological explination => Psychosis
Functional - Where there is no real explination => Neurosis

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19
Q

What is psychosis?

A

Unable to distinguish between reality and fantisy. Insight impaired with hallucinations

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20
Q

What is neurosis?

A

You are able to distinguish between reality and fantisy, you have an intact insight. However, there is anxiety low mood or obssesion

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21
Q

What are the types of stigma?

A

Felt - Where you feel that people discriminate against you because of your illness, and the perceived social rejection
Enacted - When you are actually discriminated due to your illness and the social rejection it involves

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22
Q

Advanatages of classifying mental illness

A

– Frames problem, therefore can aid diagnosis.
– Prognosis
– Guides treatment (e.g. CBT, REBT)
– Aids communication (e.g. in court, Helps explain to patient or family) and encourages concordance.
– Research purposes
– Demystify mental illness/challenge stereotypes by normalising in comparison to other health problems.

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23
Q

Disadvantages of classifying mental illness

A

– Detracts from personal issues (Holistic approach)
– Stigmatisation/labelling
– Not always possible to classify (no 2 people have all symptoms). Spectrum of diseases is present.
– Blame (people faking symptoms)

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24
Q

What is a minor?

A

A patient below the age of 18

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25
Q

How can you get consent from a child?

A

Gillick (Fraser) competence for consent to treatment if <16 yrs old. Child understands…
– Benefits, risks and complications (e.g. of treatment failure) of that treatment option, another other treatment options, inaction.
– BUT parent can override <16yr old refusal to treatment

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26
Q

What is the ICD-10?

A

The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO).

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27
Q

What is the GMC?

A

GMC – a legal body which deals with complaints about doctors (police)

Gives doctors general guidance on practising medicine and outlines the duty of a doctor, register the F1 doctors, to ensure the public receive suitable care. Although guidance produced by the GMC creates no legal duty, it does carry weight in law and the Courts have recognised the importance of such guidance.

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28
Q

What is the BMA?

A

BMA – group of doctors, philosophers, lawyers, theologians and lay people (family)

The BMA has a medical ethics department that answers individual ethical enquiries from doctors, and produces guidelines and books on ethical issues.

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29
Q

What are the stages of learning?

A

Encoding (putting info in memory) -> Storage (maintaining info.) -> Retrieval (recovering info.)

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30
Q

What is STM?

A

A temporary store of information, decays rapidly, refreshed by rehearsal. No changes to synapses.

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31
Q

What is LTM?

A

Requires consolidation, long term store, decays slowly, changes top synapses occur.

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32
Q

What part of the brain stores memories?

A

Hippocamus

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33
Q

What is implicit memory?

A

Non-declarative/procedural e.g. motor skills “draw the shape” - MEMORY FOR SKILLS

34
Q

What is explicit memory?

A

Declarative e.g. verbal skills “describe the shape” - MEMORY FOR FACTS

35
Q

What happens in amnesia?

A

Motor (implicit) and perceptual skills are preserved. Semantic knowledge is spared but episodic memory is disrupted

36
Q

What is semantic knowledge?

A

General knowledge

37
Q

Waht is episodic memory?

A

Knowledge about one’s self

38
Q

What is anterograde?

A

The inability to learn new things

39
Q

What is retrograde?

A

The inability to remeber old memories before the injury

40
Q

When are patients more likeley to remember a consultation?

A
  • The information at start and end of consultation
  • Statements which are perceived to be important by patient
  • When total amount of info is less to remember
  • When short words and sentences, and no jargon is used.
  • Material is organised and repeated
  • Higher IQ
41
Q

What is classical conditioning?

A

Acquisition -> Reinforcement -> Extinction -> Spontaneous recovery -> generalisation
Unconditioned stimulus usually leads to an unconditioned response passively. A conditioned stimulus (when a previously neutral stimulus – a sound – is associated with unconditioned stimulus) will lead to a conditioned response (learned response to previous neutral stimulus. E.G. Patient attending hospital for chemotherapy becomes nauseous on just entering hospital.

42
Q

What is operant conditioning?

A

Behaviour that becomes more or less frequent depending on the stimulus that follows it.
E.g. Patient in need of social interaction visits GP frequently, if the GP provides the social stimulation.

43
Q

How does stress affect personality?

A
  • People under stress alter their behaviour, which affects their health for example by taking up risky behaviour as a type of coping mechanism e.g. smoking.
  • Stress may influence perception of symptoms and complaint behaviour leading to higher levels of medical consultations and detection of disease.
44
Q

What is stress and what types are there?

A

Stress is a psychological response to a situation that the average person woud appraise as threatinaning and exceed his ability to cope.
There are two types:
- Traumatic stress where there is a real physical threat of injury or death (like combat)
-Non traumatic stress is a threat to the social self. The self identitiy, self esteem or confidence like what occurs during bereavement or poverty)

45
Q

What is a stressor?

A

External events that may cause stress (e.g. life events, daily hassles, chronic stressors).

46
Q

What is a stress response and strain?

A
  • Stress response - Behavioural, emotional, cognitive, physiological responses to stress
  • Strain - The effect of stress on a person.
47
Q

What is general adaption syndrome?

A

Focuses on the response to stress

  • Alarm: The fight or flight response mobilises the body to defend against the stressor.
  • Resistance: If the stress continues, the body goes into a stage where arousal remains high and the body tries to defend/adapt to the stressor
  • Exhaustion: Where physiological resources are very low, the ability to resist may collapse, and disease or death may result
  • ve: stresses of same magnitude (milk gone=no phone battery=ran out of food i.e. all stresses same) -ve: does not consider cognitive appraisal of a person’s response to stressors e.g. Person A knows there is an escaped criminal and Person B does not. They live separately. There is a noise in the garden of both Person A and B. Person A is more alert and scared as they are aware of the existence of an escaped criminal, whereas Person B does not know this information. So, Person B is not alarmed by the noise.
48
Q

What is the life change model/life events approach?

A

Focuses on stress of the stimulus
Accumulation of life events and continuous adjustment is then thought to have an effect on health. To measure stress, you can count the number of events that have occurred in a period to an individual. Examples of life events are death of a spouse, divorce, marriage, retirement, a new family member, changing jobs, injury or illness etc. Research has found that life events are associated with many illnesses, such as heart disease, cancer and depression. Questionnaires which the patient ticks on a scale and then if the overall rating is high, then this predisposes the person to conditions. -ve: (milk gone does not = the same stress as no phone battery…I can grade individual stresses) -ve: not all events in the list are bad, divorcing wife may be a good thing.

49
Q

What is the transactional model?`

A

Focuses on stress as an interaction between the person and the stressor
The demands do not match the resources. Perceived demand of the stressor can be balanced by person’s ability to cope. Ability to cope can include coping strategies, changes in personality or support. When perceived demands outweigh perceived resources this results in the psychobiological stress responses. The individual then tries to cope and the results of these efforts may affect the stressor, or the perceived demands and perceived resources.
For example, examinations are stressful for most university students; a student who copes by revising thoroughly will be more confident in their ability to pass so the exams will appear less threatening. In contrast, if a student copes by avoiding thinking about the exams and not revising or preparing for them, then the threat of the exams will increase as they draw nearer.
-ve: Doesn’t account for sudden stressors e.g. Knocking over a pan of boiling water. Lack of empirical evidence.

50
Q

What is cognative behavioural therapy?

A

Helping people see the thoughts that accompany -ve emotions/behaviours e.g. make them keep a diary
It’s carried out in three main steps:
1) Identify negative thought “ person X will kill me”
2) Remove thought “No they won’t kill you”
3) Educate to stay away from thought.

51
Q

Whate is coping?

A

(constantly changing effort to manage external and internal demands, that are appraised to be exceeding the resources of a person. You can do this by reducing demand, increase resources or dampen stress responce by e.g. medication)

52
Q

What are the coping styles?

A
  • Problem-focused coping: coping with the stressor itself.

* Emotion-focused coping: coping with the emotional reaction to the stressor.

53
Q

What is the Crisis model?

A

After being diagnosed with a chronic illness, individual loses their social status
(you can’t work etc.). This can lead to ‘biographical disruption’ (bad) or ‘negotiation’ (good)

54
Q

What occurs in a biographical disruption?

A

– Enacted stigma: occurs when a person experiences actual abuse &/or discrimination (finger pointing)
– Felt stigma: When a person feels he is being discriminated against when actually he is not.
– Different conditions have different social meanings. E.g. cirrhosis means alcoholic
– Therefore these conditions hold stereotypes
– Impairment or disability (e.g. HIV) leads to restriction in activities and social roles (due to recurrent infections). This then leads to negative labelling, which is enforced by negative social stereotypes transmitted in everyday life or media such as drug users (for HIV). This will diminish patients self esteem and cause felt stigma, leading to isolation and withdrawal from social life which eventually causes a lack of confidence and loss of skill.

55
Q

What occurs in negotiation?

A

– Person has difficulty maintaining ‘normality’ with time

– BUT they refuse to accept labelling and stigmatization; they preserve their identity

56
Q

How must patients adapt to a chronic illness?

A
  • Adjustment to symptoms and incapacities of illness
  • Adjustment to treatment procedures and hospital environment
  • Developing and maintaining relationships with health care providers
  • Preserving a reasonable emotional balance
  • Preserving a satisfactory self-image and a sense of competence and mastery (POSITIVE THINKING)
  • Sustaining positive relationships with family and friends
  • Preparing for an uncertain future.
57
Q

What types of behaviour can be expect following a chronic disease?

A

Type A Behaviour – (Pissed off) – Hostile/Impatient/competitive (learn these exact words) Leads to higher risk of CHD
Type B Behaviour – (Relaxed) – Self-evaluative/imaginative/creative (learn these exact words)

58
Q

What are the models of health and illness?

A

Bio(medical) model: Health and illness can be explained purely by disturbances in physiological processes (e.g. resulting from injury or biochemical imbalances)
Bio-psycho-social model: Health and illness affect and are affected by physiological, psychological (e.g. coping mechanisms) and social factors (e.g. social norms).

59
Q

What is a randomised controlled trial?

A

Assigning people in a research study to different groups without taking any similarities or differences between them into account.

60
Q

What is a longitudinal study?

A

Following a group throught a period of time

61
Q

What are health psychologists?

A

Health Psychologist are often Clinical Psychologists who specialise in helping individuals who are suffering from psychological consequences of physical illness or who need psychological help with managing a physical illness. GP’s refer patients to these if patient has anxiety or depression.

62
Q

What is intelligence?

A

Intelligence is the general ability to understand and use information, to think logically and adapt to new situations.

63
Q

What is the use of an intelligence quotient test?

A
  • Assessing intellectual impairment following trauma.
  • Assessing intellectual impairment associated with disease processes.
  • Diagnosing and quantifying extent of learning disabilities.
64
Q

What can affect intelligence?

A
  • poor childhood nutrition
  • exposure to environmental toxins (lead)
  • exposure to certain drugs in utero (alcohol, cocaine)
  • lack of exposure to an intellectually stimulating environment in childhood
  • neurological injury or disease
  • genetic disorders affecting brain development
65
Q

What are lay health beliefs?

A

Beliefs which the public have on their bodily functions usually spread from word of mouth or general knowledge

66
Q

What is the route for a patient to seek medical care?

A

1) They start off with perception of a symptom i.e physical, personal, social
2) They then accomidate to the symptom
3) Triggered breakdown of accommidation due to: inter-personal crisis, percieved interference with eork activities/leisure, pressure from peers, symptoms persist
4) Decision to seek help: lay referral system, GP, selfmedication

67
Q

Define loss

A

The state of being deprived of domething or someone one has had

68
Q

Define grief

A

The painful emotions associated with bereavement

69
Q

Define mourning

A

Psychological processes triggered by loss and process of recovery. The act of expressing grief

70
Q

Define bereavment

A

state of having lost someone or something to which one is emotionally attached.

71
Q

What are the stages of grief?

A

STAGE 1 – numbness, shock, (DISBELIEF)
STAGE 2 – Anger
STAGE 3 – Yearning and searching(hallucinations)
STAGE 4 – depression
STAGE 5 – Acceptance / reorganisation of mental model of world.

72
Q

What are the types of pathological grief?

A
  • Absent grief – Failure to display symptoms of grief – may result in ‘delayed’ grief or anxiety problems.
  • Prolonged grief – initially seems normal LIKE NORMAL GRIEVING. Intense grief persists and is distressing and disabling. Disabling symptoms at high levels, persisting at least 6 months after death and associated with functional impairment.
73
Q

What is the health belief model?

A

Percieved threats cause changes in health behaviour but ar influenced by a number of different factors

74
Q

Pros/cons of health belief model

A

Advantages:
-Identifies physical barriers (cost/withdrawal)
-Compares powers of different factors on the mind
Disadvantages:
-Doesn’t explain irrationality in health behaviour (not going to doctor)
-No mention of emotion/habits or social factors
-Doesn’t explain all health changes (losing weight to look good or for your health?)

75
Q

What is the theory of planned behaviour?

A

3 factors influence health behaviour change:
-Individual attitude
-Social influences
-Perceived control
These factors lead to an intention (ither positive/negative) and ultimatly lead to an action (Stop the harmful action or continue)

76
Q

Pros/cons of theory of planned behaviour

A 
Advantages:
Identifies perceived control
Identifies social norms
Disadvantages:
People don’t always do what they intend
No account of addiction
No account of future/ re-bounds (anticipatory regret)
Different morals determine different behaviours
77
Q

What is cognitive dissonace theory?

A

‘Guilty feeling’ when 2 cognitions are in conflict
Cognition 1: I do better in exams when I smoke
Cognition 2: Smoking increases my chance of lung cancer
Resolving cognitive dissonance by
Changing health behaviour (stopping smoking)
Adding a 3rd cognition (everyone in my family smokes, so what’s the point / I will stop in the new year)
Removing one or both cognitions (the odds of getting lung cancer are low)
Changing one or both cognitions (exams are more important than lung cancer – Benefit outweighs risk)
Avoiding thinking about the cognitions

78
Q

Pros/cons of cognitive dissonance

A 
Advantages:
Easy to use, making someone feel guilty is easy just add a cognition
Disadvantages:
No social/emotional factors
Purely individual
79
Q

What is the transtheoretical model?

A

Changing health behaviour has distinct, timely steps

1) Pre-contemplation- Not intending to take action in foreseeable future (6 months)
2) Contemplation- Intending to change in next 6 months
3) Preparation- Intending to take action in immediate future (next month)
4) Action- Person has made change to lifestyle within period of 6 months
5) Maintaining change- Working to prevent relapse (6 months to 5 years)

80
Q

Pros/Cons transtheoretical model

A

Advantages:
Easy to implement in daily practice
Identifies steps where people can fail
Disadvantages:
Not all people go through all the steps at the same time
Contemplation  action = wishful thinking
Change is sometimes spontaneous
Nothing negative (e.g. barriers, perceived control etc.)

81
Q

What is prime theory?

A

5) PRIME Theory
Plans for health changes only occur if:
Desire to change > desire to do something else
Impulse > inertia

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