Deck 6

Question 1

Why is confidentiality important in medical practice?

Answer 1

• It is central to establishing trust.
• Without assurances of confidentiality patients may be reluctant to provide information relevant to their care.
• Helps ensure that information is not disclosed to people who may use the information to harm the patient.
• Respecting confidentiality respects the patient’s autonomy, allows them to have control over personal information.
• Trustworthiness is part of what it is to be virtuous.
• It is a legal requirement (Human Rights and Data Protection Act).
• It is a professional obligation laid down by the GMC.

Question 2

What is considered confidential information?

Answer 2

Because this is subjective, in general, all the patients information is regarded as confidential.

Question 3

If patients can be assured of confidentiality, what would be the consequences of this?

Answer 3

Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care. But appropriate sharing is essential to the efficient provision of safe effective care, both for the individual patient and for the wider community of patients. GMC: Confidentiality (2009). However, Imparting information about a patient to those involved in the care of a patient is an important part of providing proper care and treatment. Moreover, in many cases we would be reluctant to say that disclosure of information to such people constitutes a breach of confidentiality.

Question 4

When does the GMC advise for it to be permitted to breach confidentiality?

Answer 4

Confidentiality can be breached if:

• demanded by court or statute.
• disclosure is in the public interests (e.g. necessary to prevent serious harm to other people).
• the patient lacks capacity (or is a child) and disclosure is in the patient’s best interests.
• necessary to prevent serious harm to a competent adult patient and is not practicable to seek consent to disclosure (although, if you do ask for consent and they refuse then you must obey).

When consent to divulge information is withheld, you should still seek the patient’s consent to disclosure if practicable and consider any reasons given for refusal.

Question 5

Should you disclose information about sexual contact of a serious communicable disease?

Answer 5

• You may disclose information to a known sexual contact of a patient with a sexually transmitted serious communicable disease if you have reason to believe they are at risk of infection and that the patient has not informed them and cannot be persuaded to do so.
• In such circumstances, you should tell the patient before you make the disclosure, if it is safe and practicable to do so.
• You must be prepared to justify a decision to disclose personal information without consent.
• When tracing contacts and notifying partners, you should not disclose the identify of the patient, if practicable.

Question 6

What should practical steps should be taken before making disclosures?

Answer 6

Doctors will be expected to

a) use anonymised or coded information if practicable and serves purpose.
b) be satisfied that the patient
i) has ready access to information that explains that personal information might be disclosed for sake of their own care, and for local clinical audit, and they can object

and ii) has not objected.

c) get patient’s express consent if identifiable information is to be disclosed for purposes other than their care or local clinical audit, unless disclosure it required by law or can be justified in public interest.
d) keep disclosures to the minimum necessary and
e) keep up to date with, and observe, all relevant legal requirements, including common law and data protection legislation.

Question 7

What four broad terms can activities of daily living be split into?

Answer 7

• Personal - Locomotion - Domestic/Work - Leisure

Question 8

What are common medical disruptions of ADL?

Answer 8

• Back main (most common) - Arthritis - Neck Pain - Plantar Fasciitis Often the illness is insignificant in comparison to the loss of function and ADL.

Question 9

Define Impairment.

Answer 9

Impairment is any temporary or permanent loss or abnormality of a body structure or function whether physiological or psychological. An impairment is a disturbance that affect functions.

Question 10

Define disability.

Answer 10

Disability is any restriction or lack of ability to perform an activity in the manner (or within the range considered normal mostly resulting from impairment). e.g. walking, standing, sports.

Question 11

Define handicap.

Answer 11

A disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfilment of a role that is normal for that individual.

Question 12

What is the role of occupational therapists?

Answer 12

• Functional assessment - Goal setting - Occupational issues - Quality of life

Question 13

What is the role of speech and language therapists?

Answer 13

• Help patients overcome speech and communication problems.

Question 14

What is the role of physiotherapists?

Answer 14

• Assessment of physical impairment. - Goal setting - Management (exercise, manual, hydro, electro, injection, cognitive behavioural therapies)

Question 15

During recovery the aim of patients is..

Answer 15

• Pain free - Full muscle power - Achieve normal range of movement - Full function - Promote self-management skills - Improve quality of life - Improve function/independence - Confidence.

Question 16

What methods are used to assess ADL?

Answer 16

• Observation - Patient consultation should elicit ADL problems if any - Questionnaires - Lab tests.

Question 17

What are the levels of outcome measurement?

Answer 17

Question 18

What is the medical model of disability?

Answer 18

Emphasised what was wrong/abnormal with the person

What the person could not do - a wheelchair-using student may be unable to negotiate steps

Separate education, employment, living situations

Exclusion from society

The medical model of disability individualises disability, views it as an individual tragedy, and does not account for social barriers.

Question 19

What is the social model of disability?

Answer 19

 Disabled people do not face disadvantage because of physical or mental impairments but experience discrimination in the way society is organised.

 This happens if society fails to make education, work, leisure and public services accessible, fails to remove barriers of assumption, stereotype and prejudice and fails to outlaw unfair treatment in our daily lives.

Image of an idyllic society where impairments cause individuals no problems can never exist. Some argue the model has been developed for white, middle class, heterosexual men with spinal injuries and still does not recognise the complexity of different disabled people’s lives. Some disability activists see disability as a form of social oppression involving the social imposition of restrictions of activity on people with impairments and the socially engendered undermining of their psycho- emotional wellbeing.

There have been attempts to unify these two models into what has become known as the biopsychosocial model.

Disability is not independent of the environment and is therefore not static. E.g. reduced stigma would lead to increased participation.

The radical diability model argues that disability is something externally asserted and that ‘disabled’ people are normal. E.g. deaf community who claim they are a linguistic minority.

Question 20

Give the name of two laws to protect those with disabilities.

Answer 20

Disability Discrimination Act 1995

The Act gives new rights to people who have had a disability which makes it difficult for them to carry out normal day to day activities. The disability could be physical, sensory or mental.

Equality Act 2010

You’re disabled under the Equality Act 2010 if you have a physical or mental impairment that has a ‘substantial’ and long-term’ negative effect on your ability to do normal daily activities.

Question 21

What is distributive justice?

Answer 21

How to distribute scarce resources in a way that is fair.

Question 22

What is the difference between equality and equity?

Answer 22

Equality – being the same in quantity, amount, value, intensity etc etc Equity – Fairness or impartiality; even-handedness

Hence, something can be equitable without being equal and vice versa (e.g. paying everyone the same wage would achieve equality, but would it be fair?). The healthcare system should be equitable.

Question 23

What are the main points put forward by people who support in needs based assesment?

Answer 23

Proponents of needs based assessments hold that we should make decisions about resource allocation according to need. In other words, the most equitable system of healthcare would be that which allocated resources to those who are most needy.

Question 24

The difference principle regulates inequalities. It only permits inequalities that work to the advantage of the worst off. What are the things to consider in this?

Answer 24

 But what is need? How is it measured?

 Meeting need might not be the only thing to consider

 Not everyone will chose difference principle

 Bottomless pit objection: very worst off will absorb healthcare funding because there will always be something the very worst off need to make them better off

Need isn’t the only criteria for making resource allocation choices:

 Quality adjusted life years

 Place on waiting list (first come first served)

 Likelihood of compliance with treatment

 Types of lifestyle choice the patient has made

 Ability to pay (private healthcare systems)

Question 25

What are the arguments for Lifestyle-based assessments?

Answer 25

1. Those who behave in ways that contribute to their ill health are less deserving of treatment than those who would avoid such behaviour.
2. Those who engage in behaviours that contribute to ill health and who are aware of the dangers attached to such behaviour, have forefeited their right to recieve treatment or healthcare.
3. Those who engage in behaviours that contribtue to their ill health are more likely to be deterred if they are not prioritised.
4. The benefits of treating those who do not contribute to their ill health are likely to be more substantial and longer lasting than treating those whose behaviours do contribute to their ill health.

Question 26

What are the arguments against lifestyle based assessments?

Answer 26

1. One objecting is that many who engage in high risk behaviour may not be responsible for their decisions, as may have lacked knowledge or the ability to have done otherwise regarding their risk taking behaviours.

Also, even in cases where the person is responsible, it is very difficult to establish whether the person’s behaviour is the cause of their ill health.

If so, it would seem unfair to ‘punish’ a person for something that he or she might have limited control over (or to hold that such a person has foreited any right he/she may have posessed to the provision of health care resources).

Some people people that lifestyle allocation results in deterrance from harmful lifestyle factors. However, there is no clear link and some argue that it is not the role of doctors to police patient’s lifestyles.