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Ethics and Professionalism Flashcards

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Sociology 101 flashcards
1
Q

What is error?

A

planned actions ≠ desired outcome

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2
Q

What is harm? What are the 3 types of iatrogenic harm?

A

medical care ≈ unintended physical or psychosocial injury ≈ monitoring, treatment or fatality

1) Clinical Harm
2) Social Harm
3) Cultural Harm

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3
Q

Why does harm happen?

A

Failure in: People, Activity or Environment

  1. People: training, skills, competence, fatigue, stress, needs and psychosocial contact

  2. Activity: staffing, time pressure, complexity, volume, tools and technology

  3. Environment: teamwork, staff levels, leadership, financial, standards, policy and physical environment
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4
Q

What is the Fundamental Attribution Error?

A

tendency to over-emphasise dispositional, or personality-based explanations for behaviours observed in others while under-emphasising situational explanations

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5
Q

What is quality?

A

multi-dimensional framework capturing six domains: effectiveness, efficiency, equity, safety, timeliness, patient-centerdness ≈ standard measured against a criteria ≈ degree of excellence of something

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6
Q

What are the benefits of reporting?

List 4 benefits.

A 
Maintains trust in the profession; part of candor; reduces future harm at individual and systems level; learn from mistakes; important for the safety + piece of mind of the patient and their family; integrity + trust 


\+ Trust 

+ Candor 

+ Reduces future harm at individual and systems level 

\+ Learn from mistakes 

\+ Safety 

+ Integrity 

+ Beneficence
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7
Q

What are the ethical and professional benefits of being open when things go wrong?

A

Ethical: J, B, C, NM

Professional:

  • Honesty
  • Integrity
  • Transparency
  • Trust
  • Reflection
  • Reduce future harm
  • Teaching example
  • Improve services
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8
Q

What are ethics?

A

Ethics, or moral philosophy, is the study of how to live: values, principles and rules

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9
Q

List the 4 domains of the publication GMC Good Medical Practice.

A
  1. Knowledge, skills and performance
  2. Safety + Quality
  3. Communication
  4. Trust
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10
Q

List 3 common moral theories.

A
  1. Consequentialism
  2. Deontology
  3. Virtue ethics
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11
Q

What are the 4 principles of medical ethics?

A
  1. Autonomy
  2. Non-maleficence
  3. Beneficence
  4. Justice
    (5. Confidentiality)
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12
Q

What is the doctrine of double effect? What is the four criteria for this?

A

Moral distinction between intending harm and foreseeing harm - it is not permissible to deliberately cause harm but it is permissible to cause harm through a beneficial effect (described as the harm being a foreseen but unintended side effect of the beneficial effect) 


  1. Good: action must be good, independent of its consequences - good effect (regardless of consequences)
  2. Right intention: bad effect can be foreseen, the agent must intend only the good effect - right intention for good effect
  3. Bad effect only a side effect of intended good effect: bad effect must not be a means to the good effect - cannot achieve good through bad
  4. Good > bad: good effect must outweigh, or compensate for, the bad effect - good effect > bad effect
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13
Q

List the aims of medicine regulation.

A
  • Quality, safety + efficacy 
- Appropriate manufacturing, storage, distribution + dispensed
- Detect illegal manufacturing + trade 
- Provide healthcare professionals + patients with info to enable safe use of medicines 
- Ensure promotion + advertising is fair 
- Framework to allow access to new medicines
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14
Q

What are the UK medicine regulators and what do they do?

A

MHRA:


  1. approve + licence medicines in UK

  2. monitor safety

  3. power to withdraw medicines from market



Medicines Inspectorate:

1. Issues manufacturers + wholesale dealers licences (Medicines Inspectorate - part of MHRA)

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15
Q

What guidance does the MHRA give regarding drugs?

A

Market Authorisations (‘the label’ / ‘product licence’) - the terms of this specifies what sort of conditions and patients the medicine is licensed for as described in the Summary of Product Characteristics (SmPC).

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16
Q

What two categories of drugs should you be aware of as a prescriber?

A

Unlicensed drugs + Off-label drugs;


1. Unlicensed = no UK Marketing Authorisation - including special/bespoke formulations, imported drugs, chemicals


2. Off-label = marketing authorisation but prescribed without terms of licence (different dose, age of patient, indication, route, contra-indication)

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17
Q

List the ramifications of unlicensed drugs from the prescriber’s perspective.

A
  1. Increased responsibility 

  2. Patient aware: ensure patient is aware medicine is without license (label) 

  3. Evidence: ensure sufficient evidence for use 

  4. Benefits > risk 

  5. Adequate monitoring + follow-up 

  6. Document + justify reasons for prescribing
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18
Q

List some of the key UK Medicine Legislations.

A
  1. Medicine Act 1968 - Legal framework for medicines control in UK

  2. Misuse of Drugs Act 1971 - prohibits activities of certain drugs
    
3. Misuse of Drugs Regulations 2001 - possession and supply of controlled drugs for legitimate purposes 

  3. Human Medicines Regulations 2012 - set of rules introduced pharmacovigilance requirements
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19
Q

What is the aim of the Misuse of Drugs Act 1971 and how did it stratify drugs?

A

Aims to prevent misuse of potentially dangerous drugs by stratifying them into three classes and applying penalties to their manufacture, supply or possession.

Class A: Cocaine, Heroin, Magic mushrooms

  • Possession: 7 years + fine
  • Supply: Life + fine

Class B: Cannabis, Mepherdrone

  • Possession: 5 years + fine
  • Supply: 14 + fine

Class C: Steroids, benzodiazepines

  • Possession: 2 years + fine
  • Supply: 14 + fine
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20
Q

List the 3 legal categories of medicines.

A
  1. GSL = General Sales List (= Over the Counter) - sold in pharmacies + retail outlets e.g. paracetamol


2. P = Pharmacy Only - registered pharmacy premises by pharmacist or supervised by pharmacist - OTC + P medicines with additional legal/professional considerations; check for contra-indications + advice for patients


  1. POM = Prescription Only Medicine - written by “appropriate practitioner” before sale or supply; may have more than one category of classification (dependent on formulation, strength, quantity, indication or marketing authorisation); Increasing number of medicines re-classified from POM to P to improve access to medicines with safety net of pharmacists 

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21
Q

List 4 appropriate practitioners.

A
  • Doctor
  • Dentist
  • Nurse independent prescriber
  • Pharmacist independent prescriber
  • Community practitioner nurse
  • Optometrist
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22
Q

List the 5 R’s in medicine regarding prescribing.

A
  1. Right patient 

  2. Right drug
    
3. Right dose 

  3. Right route

  4. Right time;
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23
Q

What is pharmacovigilance?

A

Post-market surveillance with: 

1) MHRA Yellow Card Scheme (reports suspected adverse reactions to any therapeutic agents, devices, fake drugs)

2) Black triangle drugs (newly licences medicines requiring intensive monitoring)


3) MHRA Drug Alerts (communicate problems to all healthcare professionals - sign up)

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24
Q

What is the role of medicine formularies?

A

produce a list of prescription drugs used by practitioners to identify drugs which offer the greatest overall value in terms of safety, efficacy and cost which should be up to date and evidence based 


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25
Q

Why is coordinating tasks of relevance in emergencies?

A

Numerous jobs to be done and required to be done in the right order and by the right person

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26
Q

Why may communication failure occur? Give reasons.

A
  • Physical constraints e.g. noise 

  • Lack of familiarity with team 

  • Differing communication styles: nurses tend to be trained not to diagnose and broad narrative in descriptions; critical care physicians tend to want focussed information and get to the question
    
- Authority gradient/hierarchy/power distance
    
- Use of jargon, abbreviations
- Cognitive biases and emotional disturbance leading to misinterpretation
    
- Cognitive load/focus on other tasks
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27
Q

What is SBAR(D)?

A

Communication strategy used in an emergency situation 


1) Situation:

i) Hello my name is… + I am a…

ii) What happened



2) Background: what else is known about patient/situation



3) Assessment: ABCDE 



4) Recommendation: I need



5) Decision: Clarify plan

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28
Q

What is IMIST?

A

Communication strategy used in an emergency situation mainly for trauma handover situations

1) Introduction: Hello my name is Jishoden and I am a F1 


2) Mechanism: Pt hit by a slow moving vehicle



3) Injuries: Femoral Fx



4) Signs/Symptoms: ABCD



5) Treatment: C-spine immobilised, leg splinted, IV access, morphine 5mg

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29
Q

What is closed loop communication?

A

Communication strategy used in an emergency situation or busy environment involving direct and specific orders to achieve a purpose

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30
Q

How do you speak up?

A

1) Probe

2) Alert 

3) Challenge

4) Emergency 


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31
Q

What is Satisficing?

A

Have minimum amount of information and requirements to identify what something is.

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32
Q

What is the cognitive miser?

A

Making up a hypothesis gives us a clearer understanding of things. We put in minimum effort to come up with an explanation. Although we cannot tell, we do the subconsciously.

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33
Q

What is heuristics? What can they lead to and what are the types of these?

A

Cognitive shortcuts. Useful and effective most of the time. We couldn’t manage without them.

1) Confirmatory bias: more likely to make a decision that supports your thinking or judgment
2) Availability Bias: Something that is in your mind, so you expect it would happen again. So, if you have witnessed something before – you would expect it to happen again
3) Anchoring: Respect a senior’s decision
4) Gamblers’ fallacy: probability of something happening again is the same

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34
Q

What is inductive reasoning? What are involved?

A

Method of reasoning whereby begin with supplying evidence for truth of the conclusion ≠ EBM ≈ opposite of deduction ≈ creating the evidence for a conclusion you preformed

  • Satisficing (minimum amount of info ≈ ID reason)
  • Cognitive miser (making hypothesis ≈ clearer understanding)
  • Heuristics (cognitive shortcuts ≈ bias)
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35
Q

List the two types of thinking with regards to deduction and reasoning.

A

Type 1: when we recognise the answer! Small decision making. Subconscious calibration

Type 2: When we have to do hypothesis deducting decision making. More energy and more reasoning

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36
Q

What is the difference between compliance and adherence?

A

Compliance is paternalistic and authoritarian whereas adherence is agreed and more power to patient 


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37
Q

What is compliance?

A

Extent to which individual complies with advice provided by a doctor

38
Q

What is adherence?

A

Extent to which individual follows agreed advice from a doctor

39
Q

What is concordance?

A

outcome of a process where doctor and patient come to mutually agreeable course of action in a shared decision-making process in line with patient-centred relationship

40
Q

List the barriers which exist for a teenager.

A
  • Complex care behaviour for T1DM required

  • Competing time, attention, context
    
- Ostracised 
- Miscommunication
    
- Misunderstanding 

  • Finance related issues
    
- Insufficient adult involvement or monitoring of adolescent self-management
    
- Cognitive, emotional or behavioural difficulties 

  • Attitudes and beliefs about self-management
41
Q

List some major predictors of poor adherence to medication.

A 
- Psychological problems 

- Cognitive impairment

- Asymptomatic disease 

- Inadequate follow-up 

- Side effects 

- Lack of belief in treatment 

- Lack of insight into treatment 
- Poor doctor-patient relationship

- Presence of barriers to care or medications 

- Complexity of treatment 

- Cost of medication
42
Q

List the 3 categories of factors impacting treatment adherence at the individual level.

A

1) Ability: misunderstanding, forgetting, schedule difficulties, physical impairment
2) Motivation: motivation to engage in + maintain health-related behaviours
3) Beliefs: Influence interpretation of information and experiences guide behaviour

43
Q

What is the IMS model and what does it aim to do?

A

Information-Motivation Strategy model is a behavioural model describing the three factors of information (illness, treatment and management understanding), motivation (willingness) and strategy (SMART) to increase adherence 
- Simplistic 

- Unidirectional

44
Q

What is the CSM model of self-regulation?

A

Common Sense Model of Self-Regulation of Health and Illness provides a flexible framework used to understand people’s response to illness by taking into account information, knowledge + motivation issues which includes emotional reactions and perceptions of internal/external stimuli/symptoms. These reactions trigger coping responses and secondary appraisal processes

  • Flexible framework accounting for information, knowledge + motivational issues
  • Promotion of emotional reactions
  • Perceptions of internal/external stimuli/symptoms
  • Reactions trigger coping responses and secondary appraisal processes
45
Q

What are treatment beliefs? What two categories can beliefs about (prescribed) medicines be grouped under?

A

Certain beliefs about medicines and interventions which are common across locations, cultures and treatment categories just like illness representations e.g. beliefs medicines are addictive + produce long term effects;

  1. Necessity: need for treatment; perceived necessity > treatment efficacy ≈adherence
    
i) Necessity beliefs 
- Dependent on medicine 
- Medicines protect 
- Negative consequential thinking e.g. if I don’t take these then…
    
ii) Efficacy beliefs vs Perceived necessity 
- Efficacy…perceived necessity ≠ efficacy belief however strong need for treatment that is moderately effective as only treatment available 

  2. Concerns: negative effects of treatment
    i) Concrete, abstract, relevant across range of disease states
    ii) Specific to particular class of medicine
46
Q

How can you assess treatment beliefs?

A

Necessity-Concerns framework using a Beliefs about Medications Questionnaire (BMQ)

i) Specific necessity scale (necessity)
ii) General harm and general overuse scale (concerns)

47
Q

What are necessity beliefs and illness representations?

A

Perceived need for treatment
i) Identity

ii) Cause
iii) Timeline and consequences
iv) Control

48
Q

What is confidentiality?

A

information disclosed to medical practitioners is not divulged to a third party, but kept privately, unless permission/consent given by the patient

49
Q

What guidance is there on confidentiality?

A
  1. Common Law
  2. Statutory Regulations
  3. GMC Guidance
50
Q

What are the common law justifications for breaking confidentiality?

A
  1. Patient’s consent 

  2. Patient’s best interests 

  3. Required by law 

  4. Public interest
51
Q

List the statutory requirements for disclosure of confidential information.

A
  • Criminal cases

  • Public health
    
- Abortions

  • Birth and Deaths
    
- Road traffic offences
    
- Fertility treatment
    
- Venereal diseases
    
- Suspicion of child abuse
    
- Terrorism
52
Q

List the professional (GMC) guidance on disclosure.

A
  • Public interest

  • Risk of harm to patient or others

  • Driving against medical advice

  • Crime 

  • HIV/AIDs
  • GP and partner
53
Q

What is the original medical model of disability?

A

The WHO published the International Classification of Impairments, Disabilities and Handicaps (ICIDH) in 1980 which defined the ‘medical model of disability’.

54
Q

List the three parts to the original model of disability.

A
  1. Impairment (Deficit): Loss or abnormality of psychological, physiological or anatomical structure + function 
(Body)
  2. Disability: Restriction or lack (due to impairment) of ability to perform an activity in the manner or within the range considered normal for a human being 
(Activity)
  3. Handicap: Disadvantage for given individual which limits or prevents fulfilment of role that is normal 
(Society)
55
Q

What is wrong with the medical model?

A

The medical model is a deficit model which emphasises deficits, problems, things that are lacking, things that are wanting, wrong, need to be fixed are not ‘normal’.

56
Q

How does the medical model in practice and the culture of medicine by physicians and family, result in the situation where we unconsciously ‘unmake’ children?

A

Medical model of disability emphasises people’s deficits, judged against a standard reference of ‘normal’ and generates identities and potentials that are less than ‘normal’ people

  1. Diagnosis difficulties
  2. ‘Normal’ expectations
  3. Parental expectations of normality + discomfort with disability
  4. Parents seek comfort + abdication from blame
  5. Limiting scenarios
  6. Prevention
57
Q

What is meant by the ‘unfinished’ body and give examples?

A

Disability produces a different body

  1. Different in ability 

  2. Lacking
    
3. In need of repair
    
4. Medical messages about repair carried out via comparisons to others 

  3. Images though which young people and families see how body could or should be reshaped
58
Q

What was the main force for change for the disability community?

A

The Disability Movement led by Paul Hunt and Vic Finkelstein represented the views of disabled people in the civil rights movement amongst disabled people which achieved numerous advancements in societal views and treatments of the disabled community e.g. Disability Discrimination Act (1995).

59
Q

What is the social model of disability?

A

The central belief that it is society which disables physically impaired people as it is imposed on top of the impairment by the unnecessary isolation and exclusion from participation. Therefore, disabled people are an oppressed group.

60
Q

List the types of discrimination of disabled people and give examples.

A
  1. Cultural: Language + Images
  2. Social: Education segregation
  3. Economic: Unemployment + Inadequate or no welfare benefits
  4. Physical: Access in built environment + Housing + Transport
  5. Behavioural: Abuse and violence + Staring + Lack of friendship and intimacy
61
Q

What are the benefits and drawbacks of the social model?

A

+ Barrier removal: Social change, Independent living, Anti-discrimination law 

+ Liberation: Re-representing impairment 

+ Representation: Nothing about us without us `

  • Divisive: Policing language without actions to substantiate
  • Silence about impairment: People with disabilities suffer inherent problems also and this normalisation my stifle conversation
62
Q

What is the International Classification of Functioning Disability and Health (ICFDH) 2002’s new definition of disability?

A

Defines disability as the outcome of the interaction between a person with impairment and the environmental or attitudinal barriers faced. Shifts the focus from disability as an individual problem towards disability as the outcome of three elements of disabling conditions and how these can be ameliorated, limited and improved to reduce the isolation of the disabled community in modern society 


63
Q

List the components of the ICFDH.

A

Impairment - Medical interventions 
(Previously impairment)


Activity limitation - Rehabilitative interventions 
(Previously disability)

Restrictions on participation - Social/political interventions 
(Previously handicap)


64
Q

What is health economics?

A

branch of economics concerned with issues related to efficiency, effectiveness, value and behaviour in the production and consumption of health and healthcare

65
Q

Why is the healthcare market highly unusual?

A

Deviates from ‘perfect market’ by failing at numerous levels:

  • Trust: Patients have to rely on doctors acting as their agent to help decide
  • Altruism: People get satisfaction or value from other people receiving healthcare
  • Unpredictability: Do not know when we will be ill or how seriously ill we will be
  • Control of output: Regulation of supply of doctors and nurses
66
Q

What is an economic evaluation?

A

comparative evaluation of both the costs and effects of two or more alternatives

67
Q

What are the three main types of economic evaluation?

A
  1. Cost-benefit analysis:
    - Outcome: expressed as health + other benefits measured and valued in monetary terms and costs then deducted
    - Results: expressed as net benefit in £s or $s if positive > costs ≈ implement intervention
  2. Cost-effectiveness analysis:
    - Outcome expressed: clinical units
    - Results: £ per case detected, per life-year saved or per acute episode avoided
  3. Cost-utility analysis:
    - Outcome: expressed in terms of QALYs or DALYs
    - Result: £ per QALY gained
68
Q

What are QALYs?

A

number of years of full health that would be equivalent to a greater number of years in a state worse than full health e.g. 10 years at half full health ≈ 5 QALYs cf 30 years at 2/3 full health ≈ 20 QALYs 


69
Q

What are DALYs?

A

Assess burden of different disease and injuries from a scale of 0-1 whereby 1 is death and 0 is health thus higher DALYs ≈ larger burden of disease

70
Q

What is the most commonly used health-related QOL questionnaire?

A 
EQ-5D health-related QOL questionnaire 

- Mobility 

- Self-care 

- Usual activities 

- Pain/discomfort 

- Anxiety/depression
71
Q

What is error?


A

planned actions ≠ desired outcome

72
Q

What is harm? What are the 3 types of iatrogenic harm?

A

medical care ≈ unintended physical or psychosocial injury ≈ monitoring, treatment or fatality

1) Clinical: direct harm
2) Social: excessive use of medicine which encourages medication more than the underlying problems e.g. reliance of anti-depressants cf social prescribing
3) Cultural: deep culturally-medicated sapping of ability to live with life and death which results in ordinary suffering becoming an illness to be treated instead of life to be lived

73
Q

Why does harm happen?

A
  1. People: training, skills, competence, fatigue, stress, needs and psychosocial contact

  2. Activity: staffing, time pressure, complexity, volume, tools and technology

  3. Environment: teamwork, staff levels, leadership, financial, standards, policy and physical environment
74
Q

What is the Fundamental Attribution Error?

A

tendency to over-emphasise dispositional, or personality-based explanations for behaviours observed in others while under-emphasising situational explanations

75
Q

What is quality?

A

multi-dimensional framework capturing six domains: effectiveness, efficiency, equity, safety, timeliness, patient-centerdness ≈ standard measured against a criteria ≈ degree of excellence of something

76
Q

List the benefits of reporting error.

A 

+ Trust 

\+ Candor 

+ Reduces future harm at individual and systems level 

+ Learn from mistakes 

\+ Safety 

+ Integrity 

\+ Beneficence
77
Q

What is the benefit of learning from error?

A

Reduce future mistakes, reflective practice, safety, competency, working within limits, prevent systems level errors, teach others

78
Q

List the ethical benefits of being open when things go wrong.

A
  1. Justice 

  2. Beneficence 

  3. Confidentiality (share knowledge)

  4. Non-Maleficence 

  5. Confidentiality
79
Q

List the professional benefits of being open when things go wrong.

A
  1. Benefit from accepting responsibility 

  2. Honesty

  3. Integrity 

  4. Transparency
    
5. Trust
    
6. Reflection

  5. Continual improvement
    
8. Reduce future harm 

  6. Teaching example 

  7. Improve services/spot weaknesses
80
Q

List the four criteria for valid consent.

A
  1. Capacity
    
2. Informed
    
3. Consent voluntarily

  2. Continuing consent 

81
Q

What is the consensus regarding freedom to make decisions (autonomy)?

A 
- Mentally competent 

- Right to refuse to consent 

- Rational or irrational 

- No reason at all

- Even if may lead to death
82
Q

List the forms of consent.

A
  1. Written consent
  2. Assumed consent
  3. Verbal consent
83
Q

What are the two approaches to capacity?

A
  1. Status: children do not, adults do


2. Function: ability to be mature + understand

84
Q

What act protects capacity? What is the criteria?

A

Adult Capacity (Adults with Incapacity (Scotland) Act (2000))

  1. Understand information 

  2. Retain information 

  3. Use or weigh the information 
4. Communicate decision 

  4. Hold decision
85
Q

List the criteria for incapacity.

A
  1. Understanding information 

  2. Retaining information 

  3. Use or weigh the information to make a decision 

  4. Communicate their decision 
5. Retain memory of decisions (hold decision)
86
Q

What makes assessing capacity difficult?

A
  • Changes: not once and for all judgement
    
- Non-cooperation
    
- Irrational decision ≠ capacity
    
- Underlying conditions may cloud our judgment
    
- Communication problems
87
Q

What is a proxy-decision making? What forms are there?

A

Someone with capacity who can make the decision on behalf of another

- Lasting power of attorney

- Advance directives

- Best interests test (HCP, relatives, carers)

88
Q

What are the problems with proxies? What do you do if a proxy is not in place?

A
  • Proxy + patient do not always agree


- Proxy decisions normally subject to best interests thus not our own decisions; 



If proxy is not in place, act in the best interest and document actions ready for justifications

89
Q

What is Gillick Competence?

A

Respect for mature minor’s autonomy provided they have the capacity. Must understand + have sufficient maturity to understand what is involved ≈ status < function (two capacity measures)

  • Landmark case 

  • Victoria Gillick and her children
    
- Centred around contraceptive advice to under-16s without parental consent
90
Q

What are the Fraser Guidelines?

A
  • Girl (although under age of 16) will understand his advice
  • Cannot persuade her to inform parents or inform parents
  • Very likely to continue having sexual intercourse with or without contraceptive treatment
  • Unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer
  • Best interests require him to give her contraceptive advice, treatment or both without parental consent
91
Q

What is voluntary consent?

A

Consent effective even when unwillingly or reluctantly given; few patients would consent to major surgery were it not for force of surrounding circumstances and knowledge that health or even life may be in jeopardy if they do not consent 


Ethics + Sociology (11 decks)

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