FoPC Flashcards
What are the values of the NHS?
- Respect and dignity
- Commitment to the quality of care
- Compassion
- Improving lives
- Working together for patients
- Everyone counts
- Care and compassion
- Openness, honest and responsibility
- Quality and team work
What are the 4 domains of good medical practice?
- Knowledge, skills and performance
- Safety and quality
- Communication, partnership and teamwork
- Maintaining trust
What is good clinical care?
- Accurately represent your position
- Recognise limits of competence
- Do not discriminate against patients
What is meant by professionalism?
Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors, with doctors being committed to integrity, compassion, altruism, continuous improvement, excellence and teamwork
What are the common concerns with professionalism?
- Attendance
- Time keeping
- Cheating
- Dress
- Attitude
- Plagiarism
- Confidentiality
- Use of social media
What percentage of cases does primary care take care of?
90%
Who is primary care?
- GPs
- General dental practitioners
- NHS 24/ NHS direct and associated staff
- Nurses- practice, district, health visitor, advanced nurse practitioners
- Midwives
- Pharmacists
- Allied health professionals e.g. physiotherapy, OT
- Physician associates (PAs)
- Practice staff e.g. receptionists, medical secretary
- Opticians
What are the variety of symptoms in the community?
- 79% self care
- 20% GP
- 1% hospital
What is confidentiality?
- Not sharing information about people without their knowledge or consent
- ensuring that written and electronic information cannot be accessed/read by people who have no reason to see it
- Keeping information safe and private
When can you disclose confidential information?
- Consent
- Disclosure required by law
- Disclosure in the public interest
- Disclosure involving patients who are children and young people under 18 years (not competent adults)
- Patients lacking capacity
- Deceased patients
Name the people who work in primary care
- Manager
- IT/Admin staff
- Secretarial staff
- Nurses: Junior/ senior
- Advanced nurse practitioners/ physicians assistants
- Phlebotomist/ health care assistants
What are the three broad types of skills needed for a successful medical interview?
- Content skills
- Perceptual skills
- Process skills
What are the three styles of doctor/patient relationship?
- Authoritarian or paternalistic relationship
- Guidance/ co-operation
- Mutual participation relationship
What are the different types of questions that can be asked in an interview?
- Open ended questions
- Direct question
- Closed question
- Leading question
- Reflected question
What are the four point that are important to consider for body language?
- Culture
- Context
- Gesture clusturs
- Congruence
What should you consider when thinking about body language?
- Gaze behaviour
- Posture
- Specific gestures
What percentage of cases can psychological factors predict?
91%
What were the leading causes of death in 2000
- Tobacco use
- Poor diet and physical inactivity
- Alcohol consumption
- Collectively accounting for almost 40% of deaths
Name 5 behavioural risk factors and give a definition of each
- Smoking: any regular/prolonged
- Overweight/ obesity: BMI>25 (overweight), >30 (obese), abdominal fat
- Poor diet: high saturated fat, salt and red/processed meat, low fibre, fruit, veg and fish
- Lack of physical activity/ sedentary behaviour: <30 mins moderate intensity activity for 5+ days/week or <20 mins vigorous intensity activity on 3+ days/week or equivalent
- Excessive alcohol consumption: >14 units for woman, >21 for men, binge drinking=6 units for woman and 8 for men
Name 5 behavioural risks and the diseases associated with them
- Smoking: CVD (e.g. high BP, CHD, stroke), chronic obstructive pulmonary disease, some cancers
- Overweight/obesity: CVD, type 2 diabetes, some cancers
- Poor diet: obesity, type 2 diabetes, CVD, some cancers
- Lack of physical activity: obesity, type 2 diabetes, CVD, osteoporosis, back pain, some cancers
- Excessive alcohol consumption: obesity, liver disease, cardiovascular disease, some cancers, diabetes, osteoporosis, pancreatitis, psychiatric disorder
What works best for changing behaviours?
- Targeting women and older people
- Shorter interventions
- Those which clearly map what that do to change processes
What is the NICE 2015 behaviour change pathway?
- Behaviour change
- Training in behaviour change
- Principles for planning
- Principles for assessing social context
- Principles for selecting interventions and programmes aimed at individuals
- Principles for selecting interventions and programmes aimed at communities
- Principles for selecting interventions and programmes aimed at populations
- Evaluation
Give some examples of population level policies, interventions and programmes tailored to change specific health-related behaviours
- Fiscal and legislative interventions
- National and local advertising and mass media campaigns (for example information campaigns, promotion of positive role models and general promotion of health-enhancing behaviours)
- Point of sale promotions and interventions (for example, working in partnership with private sector organisations to offer information, price reductions or other promotions)
Give some examples of community level policies, interventions and programmes tailored to change specific health-related behaviours
- Support organisations and institutions that offer opportunities for local people to take part in the planning and delivery of services
- Support organisations and institutions that promote participation in leisure and voluntary activities, promote resilience and build skills, by promoting positive social networks and helping to develop relationships
Give examples of what commissioners, service providers and practitioners working with individuals interventions that they can select
- They should motivate and support individuals
- Feel positive about benefits of health-enhancing behaviours and changing their behaviours
- Plan their changes in terms of easy steps over time
- Recognise how social contexts and relationships may affect their behaviours
- Plan explicit “if-then” coping strategies to prevent relapse
What must information be to influence actions/behaviours?
- Relevant to current goals
- Easy to understand
- Readily available in the moment of decision or action
What motivates people to change?
- The advantages out way the disadvantages
- You anticipate a positive response from others to your behaviour change
- There is social pressure for you to change
- You perceive the new behaviour to be consistent with your self image
- You believe you are able to carry out the new behaviour in a range of circumstances
What does self-efficacy underpin?
- Goal setting
- Effort investment
- Persistence in the face of barriers
- Recovery from setbacks
What has research shown about changing behaviour?
- Neither willpower or knowledge alone lead to long-term change
- Small steps are more successful than big leaps
- Environment is important- change this to make the change work
- Create new behaviours rather than just avoiding old ones
- Don’t under-estimate the power of triggers
- Goals have to be concrete
- Set short term goals which help towards the long term goal
What is a smart goal?
- S: specific
- M: measurable
- A: achievable
- R- Realistic
- T: timely
What is a hazard?
Something with potential to cause harm
What is a risk?
The likelihood of harm occurring
What is a risk factor?
Increases the risk of harm
What is a protective factor?
Decreases the risk of harm
What is susceptibility?
Influences the likelihood that something will cause harm
Give a list of the types of hazards
- Physical: wet floors, loose electrical cables, objects protruding in walkways or doorways
- Chemical: Alkali solvents
- Mechanical
- Biological: hepatitis B, new strain influenza
- Psychological: heights, loud sounds, tunnels, bright lights
- Ergonomic: lifting heavy objects, stretching the body, twisting the body, poor desk sitting
What are the roots of exposure to hazards?
- Skin
- Blood/sexual
- Inhalation
- Ingestion
What are the factors that influence the degree of risk?
- How much a person is exposed
- How the person is exposed
- Conditions of exposure
What are the three principles that govern the perception of risk?
- Feeling control (voluntary v.s. involuntary)
- Size of the possible harm (more harm is worse than more likely)
- Familiarity with the risk
What are the individual variables in risk perception?
- Previous experience
- Attitudes towards risks
- Values
- Beliefs
- Socio economic factors
- Personality
- Demographic factors
What are the direct pathological effects of the environment?
-Physical: Ionising and non-ionising radiation, noise and vibration
Chemical: pesticides, VOCs (volatile organic compounds)
-Biological: infectious agents, allergic substances
What are the indirect effects of the environment?
- Housing e.g. overcrowding
- Transport e.g. does it encourage walking or car use
- Town planning e.g. access to amenities, social networks
- Income/ welfare/ wealth distribution
Give examples of hazardous exposure in diet?
- Fat
- Salt
- Bacteria
- Pesticides
- Acrylamide
- Phthalates
Give examples of hazardous inhalation exposure?
- Environmental tobacco smoke
- Smog
- Asbestos
- Legionella
- Pesticides
Give examples of dermal hazardous exposure
- UV-A/UV-B
- Bacteria
- Cosmetics
- Pesticides
How many occupational fatal injuries were there in 2010/11 in the UK?
171
How many occupational non-fatal injuries were there in 2010/11 in the UK?
Over 100,00 (1 in 2000)
How many death each year are a result of past exposure to harmful working conditions?
12000
How many deaths are related occupational cancer each year?
8000
How many deaths are related Asbestos each year?
4000
How many COPD deaths are there that are related to past occupational exposure to fumes, chemicals and dust
4000
How many cases of ill health each year are caused or made worse by work?
1.2 million
What is a cigarette?
- Tobacco (different types)
- Filter
- Filler
- Additives
- Paper
- Smoke
How many Scots die each year prematurely from smoking?
13,000
How many Brits die each year prematurely from smoking?
120,000
How many years, on average, do you loose from life as a smoker?
7.5 years
What fraction of pregnant women smoke?
1/3
What type of woman is more likely to smoke during pregnancy?
- Younger
- Single
- Lower educational achievement
- Male partner more likely to smoke
How much does the risk increase of miscarriage, still birth and neonatal death?
1/3
What percentage of woman start smoking again after birth?
2/3
What can second hand smoke cause in children?
- Respiratory infections
- Bronchitis
- Bronchiolitis
- Pneumonia
- Cot death
- Middle ear infection
What is the risk of an MI for someone who has stopped smoking for a year?
50% that of a smoker
What is the risk of an MI for someone who has stopped smoking for 15 years?
the same as a life long non-smoker
What is the risk of lung cancer for someone who has stopped smoking for 10-15 years?
Only slightly greater than that of a non smoker
What is the percentage of the cost of a pack of cigarettes that is tax?
77%
What is the cost of treating smoking related diseases to the NHS?
£3-5 billion
How are children protected from cigarettes?
- You can’t sell tobacco products to anyone under 18
- You can’t smoke in a private vehicle with children in it
- You can’t proxy purchase
- You can’t sell cigarettes in vending machines
What is the standardised packaging of tobacco products?
- Picture warnings must take 65% of surface of pack
- Ban on distinguishable flavours e.g. menthol
- Minimum pack size of 20
- Limits on tar, nicotine and CO
- Terms such as “mild” and “ultra-smooth” banned
What are the exceptions for smoking in public places?
- Hotel and guest house bedrooms
- Designated rooms in care home, hospices and prisons
- Private home
- Places not “substantially enclosed”
- Actors
- Specialist tobacco shops
What can you do to help people stop smoking?
- Don’t smoke yourself
- Be supportive
- Used skilled people around you e.g. smoking advisory service
Give some reasons someone would want to give up smoking if they have a significant history of it
- Recent health scare
- Pressure from friends and family
- Wanting to set a good example to children/grandchildren
- Save money
- Protect his family
Who can help people stop smoking?
- Local pharmacist: 12 week 1 to 1 programme using pharmacological and non-pharmacological ways to stop smoking
- Smoking advice service: helps offer pharmacological and non-pharmacological support in a variety of formats (groups, one to one, telephone advice and even at home)
- GP
Where else can someone get smoking cessation advice from?
- Internet
- Information leaflets
- Stop smoking apps
- Telephone helplines
- Healthpoints
What are the non-pharmacological options for stopping smoking
- Make a list of all the reasons he wants to stop smoking- stick them somewhere prominent
- Set a date to stop completely
- Prepare for quit date by throwing away lighter, cigarettes, ashtray and collecting prescription
- Review previous attempts to stop smoking and what helped/hindered
- Plan ahead- identify problems by describing a typical smoking day and identify tricky times/ situations and develop strategies to cope
- Group support
- Counselling
What are the different nicotine replacements?
- Chewing gum
- Transdermal patches
- Inhalator
- Lozenge
- Sublingual tablet
- Nasal spray
- Mouth spray
- Quick strips
What other pharmacological methods are there for smoking cessation?
- Verenicline (champix, 12 week coarse)
- Bupropion (zyban, 7-9 week coarse)
how many languages are spoken in each surgery?
6-8
What percentage showed clear misunderstanding?
31%
How many of these misunderstandings were with patients with limited english?
73%
What is culture?
- It is the learned and shared values of a particular group that: guides thinking, actions, behaviours and emotional reactions to daily living
- It is the sum of beliefs, practices, habits, likes and dislikes
- It is norms and customs that are learned
What does culture influence?
- Behaviour
- Diet
- Attitudes to healthcare
- language
- Perceptions
- Family structure
- Body image
- Religion
- Beliefs
- Rituals
- Personal space
- Attitudes to illness
- Dress
- Emotions
How are cultural differences central to the delivery of healthcare?
- It influences patients’ healthcare beliefs, practices, attitudes towards care, trust in the system and the individual providers
- Cultural differences affect how health information and healthcare services are received, understood and acted upon
What are the three influences of culture in healthcare
- Misunderstandings in diagnosis or in treatment planning arising from differences in language or culture
- Poor patient adherence with treatments, and poor outcomes
- Health care disparities
What is transference?
- It occurs when the physicians or patients transfer past emotions, beliefs or experiences to the present situation
- The feelings can be positive or negative (counter-transference), but are always a distortion of reality
- Transference is an unconscious process. When transference occurs around cultural issues, it becomes a serious barrier that keeps the patient from being receptive to medical advice and treatment
What are the barriers of multi-cultural medicine?
- Lack of knowledge
- Fear and distrust
- Bias and ethnocentrism
- Stereotyping
- Language barriers
- Differences in perceptions and expectations
- Situation
What is cultural competence?
The ongoing capacity of healthcare systems, organisations and professionals to provide for diverse patient populations high quality care that is safe, patient and family centred, evidence based and equitable
What are the language interpreters that are available?
- Phone interpreters
- On site interpreters
- Family member (least desirable)
Why is using a family member as an interpreter the least desirable option?
it equates to:
- error
- Lack of knowledge
- biases
- selective communication
What are the WHO rankings of healthcare systems based on?
- Health (50%): disability-adjusted life expectancy
- Responsiveness (25%): speed of service. protection of privacy and quality of amenities
- Fair and financial contributions (25%)
What is the definition of a health policy?
All policies which have a direct bearing on health.. includes, among others, income security, employment, education, housing, business, agriculture, transportation, justice and technology
What modifiable factors influence health?
- Economics and social
- Living and working conditions
- Medical care
- Personal behaviour
What are the explanatory variables that can cause impact on public health?
- Democracy
- International rivalry
- Civil conflict
- Ethano-religious cleavages
- Income inequality
- Rapid urbanisation
- Level of educational attainment
- Level of economical attainment
What are the causal impacts that can affect public health?
- Level of resources available for allocation to public health
- Resources actually allocated to public health
- Productivity: efficiency of health system at utilising allocated resources
- Exposure of population to risk factors
What are the social inequalities?
- Class
- Race/ethnicity
- Immigration
- Status
- Gender
- Sexual orientation
What are the institutional powers?
- Corporations and businesses
- Government agencies
- Schools
- Laws and regulations
- Non-profit organisations
What health policy is in place to combat social inequality and institutional power?
Strategic partnerships advocacy
What are the living conditions that influence health?
- Physical environment: Land use, transportation, housing, residential segregation, exposure to toxins
- Social environment: Experience of class, racism, gender, immigration culture, media violence
- Economic and work environment: employment, income, retail businesses, occupational hazards
- Service environment: Health care, education, social services
What healthcare policies are in place for living conditions?
- community capacity building
- Community organising
- Civic engagement
What are risk behaviours?
- smoking
- Poor nutrition
- Low physical activity
- Violence
- Alcohol and other drugs
- Sexual behaviour
What are the health care policies that are in place for risk behaviours?
- Individual health education
- Case management
What are the diseases and injury?
- Communicable disease
- Chronic disease
- Injury (intentional and unintentional)
What are the health care policies in place for diseases and injuries?
- Health care
- Case management
What is health strongly influenced by?
- The wealth and equality of a nation
- Political decision making/policies
- Economic spend and control
- Legalisation
What are the duties of a doctor with the GMC?
- Make the care of your patient your first concern
- Treat every patient politely and considerably
- Respect every patients’ dignity and privacy
- Listen to patients and respect their views
- Gave patients information in a way they can understand
- Respect the rights of patients to be fully involved in decisions about their care
- Keep your professional knowledge and information up to date
- Recognise the limits of your professional competence
- Be honest and trustworthy
- Respect and protect confidential information
- Make sure that your personal beliefs do not prejudice your patients’ care
- Act quickly to protect patients from risk if you have good reason to believe that you or a college may not be fit to practice
- Avoid abusing your position as a doctor
- Work with colleagues in the ways that best serve patients’ interests
What is the definition of ethics?
The body of moral principles or values governing or distinctive if a particular culture or group
What comprises ethics?
- Principles
- Values
- Honesty
- Standards, rules of behaviour that guide the decisions procedures and conduct of individuals that respect the right of all stakeholders affected by its operations
What is meant by morality?
Our attitudes, behaviours and relations to one another
What is consequentialism?
The moral worth of an action is determined by its outcome
What is deotology?
Duties, “right” and “wrong” actions, absolute values
What is utilitarianism?
Look at the benefits and harms to individual and society; look at the consequences (type of consequentialism)
What are the 4 principles of health care?
- respect for autonomy
- Non-malfeasance
- Beneficence
- Justice
Explain the respect for autonomy
- Promote the right to self determination
- Confidentiality
- Informed consent
- promote capacity
Explain non-malfeasance
The avoidance of harm
Explain beneficence
To do good
Explain justice
- Fairness/ equality: non discrimination, equal treatment for equal need
- Individual vs. population: rationing, limits to autonomy
What is the duty of candour?
You must apologies to the patient and offer an appropriate remedy or support to put matters right (if possible) and explain fully the short and long term effects of what has happened
What are the tasks of a consultation from a doctors point of view as listed by neighbour?
- To connect to the patient
- To summarise and verbally check that reasons for attendance is clear
- To hand over and bring a consultation to a close
- To ensure that a safety net exists in that no serious possibilities have been missed
- To deal with housekeeping of recovery and reflection
What is the definition of uncertain?
Not be relied on; not know or definite
What does uncertainty mean?
(personal) State of being not completely confident or sure of something
Give examples of national guidance that help you deal with uncertainty
- SIGN guidelines
- NICE guidelines
Give an example of local guidelines for dealing with uncertainty
Scottish referral guidelines for suspected cancer
Why do medical errors occur?
- Large and varied workforce working with patients
- Administrating the wrong drug can be fatal
- Team issues
- Technical failures
What are the cognitive biases that can cause a medical error?
- Attention
- Memory loss
- Automaticity
- Situation awareness
- Availability heuristic
- Confirmation bias
How does fatigue affect communication?
- Difficulty finding and delivering the correct word
- Speech less expressive
How does fatigue affect us socially?
- Become withdrawn
- More acceptance of our own errors
- Loss of tolerance for others
- Neglect small tasks
- Less likely to converse
- Increasingly irritable
- Increasingly distracted by discomfort
How does fatigue affect our thinking?
- Less able for innovative thinking and flexible decision making
- Less ability to cope with unforeseen rapid changes
- Less able to adjust plans
- Tendency to more ridged thinking
- Lower standards of performance become acceptable
How does fatigue affect our motor skills?
- Less co-ordination
- Poor timing
How many regional boards are in NHS Scotland?
14
What is the WHO definition of health?
Health is a state of complete mental and social well-being and not merely the absence of disease or infirmity
Why is a global perspective to health important to the world’s future?
- Collective humanitarian action
- More cost effective for the world community
- Provides public health security in an interconnected world
- Contributes to health equity
- Minimized negative impact on economies
What were the millennium development goals of 1990-2015 ?
- Eradicate extreme poverty and hunger
- Achieve universal primary education
- Promote gender equality and empower woman
- Reduce child mortality
- Improve maternal health
- Combat HIV/AIDS, malaria and other diseases
- Ensure environment sustainability
- Global partnership for development
What are the sustainable development goals of 2016-2030?
- No poverty
- Zero hunger
- Good health and well being
- Quality education
- Gender equality
- Clean water and sanitation
- Affordable and clean energy
- Decent work and economic growth
- Industry, innovation and infrastructure
- Reduce inequalities
- Sustainable communities and cities
- Responsible consumption and production
- Climate action
- Life below water
- Life on land
- Piece, justice and strong institutions
- Partnerships for the goals
What is global health?
An area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasises transnational health issues, determinants and solutions; involves many disciplines with and beyond the health sciences and promotes interdisciplinary-based collaboration; and is a synthesis of population-based prevention with individual-level care
What were the top 10 leading causes of death world wide in 2012?
- Ischaemic heart disease
- Stroke
- COPD
- Lower respiratory tract infection
- Trachea, bronchus, lung cancers
- Diabetes mellitus
- Alzheimer disease
- Diarrhoeal diseases
- TB
- Road injury
What are the structural determinants of health inequities?
- Governance
- Macroeconomic policies
- social policies (labour market, housing, land)
- Public policies (education, health, social protection)
- Culture and societal values
- Socioeconomic position: social class, gender, ethnicity (racism), education, occupation, income
What are the intermediary determinants of health?
- Maternal circumstances (living and working condition, food availability, etc.)
- Behaviours and biological factors
- Psychological factors
- Health system
How many people die from water, sanitation diseases each year?
1.5 million people
What is the definition of water born diseases?
- Caused by the ingestion of water contaminated by human or animal faeces or urine containing pathogenic bacteria or viruses
- Now also includes pollutants/contaminants
What is the definition of water-washed diseases?
caused by poor personal hygiene and skin or eye contact with contaminated water
What is the definition of water based diseases?
caused by parasites found in intermediate organisms living in contaminated water
What is the definition of water related diseases?
Caused by insect vectors, especially mosquitoes, that breed in water
Why are intervention strategies of all diseases related to water?
- Improve water supply: boreholes, protected wells, standpipes, piped water to households
- Water quality interventions: source, point of use methods
- Personal hygiene: education, hand-washing
- Sanitation: toilets, ventilated pit latrines, standard pit latrines
Why is global health so important for doctors?
- Changing world and the needs for health professionals in the 21st century
- Opportunity to strengthen skills of individual doctors (irrespective of career path)
