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Human endeavour > Doctor-patient relationship > Flashcards

Doctor-patient relationship Flashcards

1
Q

An indigenous healer

A

Shaman

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2
Q

Who was the god of healing?

A

Apollo

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3
Q

Who was associated with health and disease?

A

Asklepios

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4
Q

Who was the first person to believe that diseases were caused naturally and not because of superstition?

A

Hippocrates

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5
Q

What did Hippocrates promote?

A

Natural theories of health and sickness and natural modes of healing

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6
Q

Evolution of medical theories

A
  1. Preternaturalistic: divine punishment
  2. Hippocratic revolution
  3. Naturalistic: ontological/functional concepts
  4. 1940s, 1960s socio-cultural
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7
Q

What do Hippocratic doctors pledge?

A

To do no harm: demonstrates the physician’s devotion to his art rather than fortune

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8
Q

What is the physician excellent at in the modern age?

A
  1. Anamnesis [complete clinical history of a patient]
  2. Differential diagnosis
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9
Q

3 reasons why the doctor-patient relationship is important

A
  1. Bioethical reason
  2. (Neuro)ethical reason
  3. Legal reason
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10
Q

What were the 2 trigger events that led to human research subject protection?

A
  1. Nurember war tribunal (1947)
  2. Syphilis study in Tuskegee GA, USA 1932-1972
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11
Q

Describe the Syphilis study in Tuskegee GA, USA 1932-1972

A
  • 600 low-income AA males, 400 of whom were infected with syphilis were monitored for 40 years
  • free examinations given, but the patients were not told about their disease
  • even though there was a treatment for syphilis in the 50s, the participants were denied treatment unit 1972
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12
Q

Who created the Belmont report?

A

the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research was created after the National Research act of 1974

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13
Q

What are the 3 basic ethical principles?

A
  1. Autonomy
  2. Beneficence
  3. Justice
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14
Q

What is autonomy?

A

Individuals should be treated as autonomous agents: need to be informed about treatments and all risks and benefits

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15
Q

What is beneficence?

A

Do no harm, maximum possible benefits and minimize potential harm

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16
Q

What is justice?

A

Fair distribution of burdens and benefits of research

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17
Q

What is the placebo effect?

A

The positive physiological or psychological changes associated with the use of inert medications, sham procedures or therapeutic symbols within a healthcare encounter

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18
Q

What are placebos?

A

Inactive substances used to compare results with active substances

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19
Q

What are sham treatments?

A

Doctor goes through the motions without performing the treatment

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20
Q

What did sham surgeries prove in a review in 2014?

A

The sham surgeries provided some benefit in 74% of the trials

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21
Q

What is an open injection?

A

Injection carried out by a doctor at the bedside who told the patient that the injection was a powerful analgesic

22
Q

What is a hidden injection?

A

The same analgesic dose was performed by an automated infusion machine which started without the doctor/nurse

23
Q

What was seen about hidden/open injections?

A

The analgesic dose to reduce the pain by 50% was much higher for hidden infusions that for open ones

24
Q

Which 4 painkillers were studied in the open/hidden injection study?

A
  1. Metamizole
  2. Ketorolac
  3. Tramadol
  4. Buprenorphine
25
Q

What does an open injection activate?

A

The endogenous opioid systems through expectation pathways

26
Q

What are dopamine pathways?

A

Expected reward for a behaviour performed

27
Q

What is stressed-induced analgesia?

A

It is a well-known phenomenon when soldiers are wounded in battlefield but feel no pain until the battle is over

28
Q

What is anxiety- induced hyperplasia?

A

The modulation of pain by emotion and context is widely recognised. Fear and pain can exacerbate pain

29
Q

What is nocebo hyperplasia?

A

How anxiety is turned into pain: attention is focused on pain and cholecystokinin

30
Q

What factors mediate the placebo effect?

A
  1. associative learning/ conditioning processes
  2. Cognitive factors such as the patient’s expectation of a benefit from a treatment
  3. quality of doctor-patient communication
31
Q

What promotes enhanced health and well-being?

A

Social contact

32
Q

Where is dopamine produced?

A

In the ventral tegmental area (VTA)

33
Q

Where is dopamine sent?

A

to the amygdala, nucleus accumbens, prefrontal cortex and hippocampus

34
Q

What is serotonin responsible for?

A

Feelings of satiation

35
Q

What are part of the mesolimbic pathways?

A
  1. Nucleus accumbens
  2. Amygdala
  3. Hippocampus
36
Q

What does the amygdala mediate?

A

Decisions about reliability of people and situations in 1/10th of a second the brain judges the reliability of a face

37
Q

What increases confidence and trust?

A

Oxytocin

38
Q

What is a mirror neuron?

A

A neuron that fires both when an animal acts and when the animal observes the same action performed by another

39
Q

Neurotransmitters involved in the placebo response

A

endogenous opioids
endocannabinoids
dopamine
cholecystokinin CKK

40
Q

Instead of administering drugs, what is something equally good that a physician can do?

A

Empathy and motivating them positively

41
Q

What is medical malpractice?

A

A legal cause of action that occurs when a medical or health care professional deviates from standards in hi/her profession, thereby causing injury to a patient

42
Q

What is defensive medicine?

A

Refers to the practive of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against a patient as a potential plaintiff

43
Q

What forms can defensive medicine take?

A
  1. Assurance-bureaucratic behaviour
  2. Avoidance behaviour
44
Q

What is defensive medicine a burden on?

A

health care costs

45
Q

What is assurance-bureaucratic behaviour?

A

involves the charging of additional services

46
Q

What is avoidance behavior?

A

Occurs when providers refuse to participate in high risk procedures or circumstances

47
Q

What increases the risk of non-adherence in patients?

A

poor physician communication

48
Q

Which routine visits tend to be longer?

A

With no-claims primary care physicians were longer than claims primary care physicians

49
Q

What is the range of consultation time?

A

22s in Bangladesh
22.5 min in Sweden

50
Q

What is the average consultation time?

A

5 min or less

51
Q

What can medical literacy do?

A

Improve doctor-patient communication and therefore the patient’s health

Human endeavour (30 decks)

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