Ethics and Professionalism Flashcards

Question

Why is coordinating tasks of relevance in emergencies?

Answer 1

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

Answer 2

- 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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

1) Probe  2) Alert   3) Challenge  4) Emergency  

Answer 7

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

Answer 8

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.

Answer 9

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

Answer 10

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)

Answer 11

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

Answer 12

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

Answer 13

Extent to which individual complies with advice provided by a doctor

Answer 14

Extent to which individual follows agreed advice from a doctor

Answer 15

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

Answer 16

- 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

Answer 17

``` - 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 ```

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

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

Answer 22

Necessity-Concerns framework using a Beliefs about Medications Questionnaire (BMQ) i) Specific necessity scale (necessity) ii) General harm and general overuse scale (concerns)

Answer 23

Perceived need for treatment i) Identity ii) Cause iii) Timeline and consequences iv) Control

Answer 24

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

Answer 25

1. Common Law 2. Statutory Regulations 3. GMC Guidance

Answer 26

1. Patient’s consent   2. Patient’s best interests   3. Required by law   4. Public interest

Answer 27

- Criminal cases  - Public health  - Abortions  - Birth and Deaths  - Road traffic offences  - Fertility treatment  - Venereal diseases  - Suspicion of child abuse  - Terrorism

Answer 28

- Public interest  - Risk of harm to patient or others  - Driving against medical advice  - Crime   - HIV/AIDs - GP and partner

Answer 29

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

Answer 30

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)

Answer 31

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’.

Answer 32

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

Answer 33

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

Answer 34

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).

Answer 35

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.

Answer 36

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

Answer 37

+ 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

Answer 38

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  

Answer 39

Impairment - Medical interventions  (Previously impairment)  Activity limitation - Rehabilitative interventions  (Previously disability) Restrictions on participation - Social/political interventions  (Previously handicap) 

Answer 40

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

Answer 41

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

Answer 42

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

Answer 43

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

Answer 44

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  

Answer 45

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

Answer 46

``` EQ-5D health-related QOL questionnaire  - Mobility   - Self-care   - Usual activities   - Pain/discomfort   - Anxiety/depression ```

Answer 47

planned actions ≠ desired outcome

Answer 48

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

Answer 49

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

Answer 50

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

Answer 51

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

Answer 52

```  + Trust   + Candor  + Reduces future harm at individual and systems level  + Learn from mistakes   + Safety  + Integrity   + Beneficence ```

Answer 53

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

Answer 54

1. Justice   2. Beneficence   3. Confidentiality (share knowledge)  4. Non-Maleficence   5. Confidentiality

Answer 55

1. Benefit from accepting responsibility   2. Honesty  3. Integrity   4. Transparency  5. Trust  6. Reflection  7. Continual improvement  8. Reduce future harm   9. Teaching example   10. Improve services/spot weaknesses

Answer 56

1. Capacity  2. Informed  3. Consent voluntarily  4. Continuing consent  

Answer 57

``` - Mentally competent  - Right to refuse to consent  - Rational or irrational  - No reason at all  - Even if may lead to death ```

Answer 58

1. Written consent 2. Assumed consent 3. Verbal consent

Answer 59

1. Status: children do not, adults do  | 2. Function: ability to be mature + understand

Answer 60

Adult Capacity (Adults with Incapacity (Scotland) Act (2000)) 1. Understand information   2. Retain information   3. Use or weigh the information  4. Communicate decision   5. Hold decision

Answer 61

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)

Answer 62

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

Answer 63

Someone with capacity who can make the decision on behalf of another  - Lasting power of attorney  - Advance directives  - Best interests test (HCP, relatives, carers)

Answer 64

- 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

Answer 65

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

Answer 66

- 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

Answer 67

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  