Deck 4 Flashcards
What is Medicalisation?
Medicalisation is the process of defining an increasing number of life’s problems as medical problems. E.g. 19th century - too much jerking off was a disease, 2018, one can’t wank enough.
What is Pharmaceuticalisation?
It is a complex social process involving the development, commercialisation and use of pharmaceutical products. It is defined as the transformation fo the human condition / capabilities into opportunites for pharmaceutical inervention. Includes non-medical uses - lifestyle enhancement (e.g. modafanil) amongst the health.
What gender sterotypes still exist and serve as a problem when seeking healthcare?
- Women’s bodies - ‘soft’
- Men’s bodies ‘ hard’
- Expectations not real.
Compare the doctors story with the patients story in regards to CAM.
What is consent?
In a medical context, consent is the properly informed and freely given decision of a competent patient. There are many different forms of consent.
What forms of consent exist?
- Oral consent.
- Written consent.
- Expressed (i.e. a way which is clearly articulated).
- Implied (e.g. holding out arm for a blood pressure measurement).
Consent of the patient is required before examination, treatment, care, disclosure of confidential information (some exceptions), screening, teaching, research.
Why is consent needed?
- Patients more likely to trust doctors.
- Failure to get consent may give rise to harm.
- Getting consent is to respect patients autonomy and right to self-determination.
- A professional requirement.
- A legal requirement (failure to do so can lead to claims of battery and neglect).
- Failure to do so can have serious professional and personal reprecussions.
What is Battery?
Battery is when a person touches another person without his/her consent. Unlike with negligence, it need not be the case that actual harm is committed. For a negligence claim to be successful, the claimant needs to show a causal connection between the failure to inform adequately (about risks and implications) and the resultant harm.
There has been a transition from the ‘reasonable doctor standard’ to the ‘reasonable patient standard’. What does this mean?
The reasonable doctor standard follows the Bolam principle – “practitioners are not negligent if they act in accordance with the practice accepted by a responsible body of medical opinion”.
The reasonable patient standard states that if there is significant risk which would affect the patients decision about a treatment, then it is the doctors responsibility to inform the patient and allow them to decide.
It is now accepted as a duty of doctors to inform patients about the risks involved, although in circumstances where the procedure is objectively in the best interests of the patient, this duty may be excused.
In the context of consent, patients must be able to make an informed choice. Information must be tailed to the patients..?
- Needs, wishes and priorities.
- Level of their knowledge and understanding of condition and prognosis.
- Nature of their condition.
- Complexity of the treatment
- Nature and level of risk associated with the treatment.
Clinicians should not make assumptions about:
- The information the patient may want or need.
- The clinical or other factors a patient may see as signiciant.
- The patients level of knowledge and understanding of what is proposed.
What other information nuggets must patients get as part of informed consent?
The diagnosis or prognosis
Uncertainties about the diagnosis or prognosis, including options for further
investigation
Options for treating and managing the condition, including not treating
The purpose of any proposed investigation or treatment and what it will involve
Potential benefits, risks, burdens and the likelihood of success for each option
Whether the proposed intervention is part of a research programme
The people who will be responsible for and involved in their care and what their
roles are
Their right to refuse to take part in teaching or research
Their right to seek a second opinion
Any bills they will have to pay
Any conflicts of interest that you or your organisation may have
Any other treatments you think have greater benefit that you cannot offer
Should explore these matters with patients, listen to their concerns and respect their views – encouraging them to ask questions. Check the patients understanding of the information they have been given and whether or not they would like more information. You must make it clear they can change their minds at any time. You must answer their questions honestly and, as far practical, as fully as possible.
What is voluntary consent?
Patient must be acting according to their own free will and not be under undue pressure from other parties (except when lacking capacity).
What does capacity mean in terms of vaid consent?
In order for consent to be valid, the patient must have capacity. Patients should be presumed to have capacity regardless of their condition, and capacity is decision and time specific. A patient can be described as competent when their cognitive faculties are such that they are able to make a decision with respect to the given situation. Capacity is a legal term, and is used to describe patients with legally recognised decision-making authority.
The test of capacity adopted by the Mental Capacity Act 2005 can be divided into three stages:
Can the patient….
understand
retain
weigh up
and, communicate
What is self-medication?
Self medication is the ability to select and use medication to treat self-diagnosed illness or symptoms. It can be thought of as an element of self care.
What is self-care?
Elf care is individuals’ taking responsibility for their own health and wellbeing. This includes actions people take for themselves everyday in order to stay fit and maintain good physical and mental health, meet their social and psychological needs, prevent illness or accidents and care more effectively for minor ailments and long term conditions.
Over the counter (OTC) medicines are those which can be purchased without a prescription. In 2011, 964 million packs of OTC medicines were bought, compared with 1064 million on prescription.
There are 57 million GP appointments per year for minor ailments such as coughs and colds. This takes up an average of an hour a day for every GP, costing the NHS £2 billion.
