Formative Exam Preparation Flashcards
Name 3 types of DOCTOR/PATIENT RELATIONSHIP (Szasz and Hollander)
1) Mutual Participation
2) Authoritarian/Paternalistic
3) Guidance/ Co-operation
What is an AUTHORITARIAN/PATERNALISTIC relationship?
The physician uses all of the authority inherent of their status and the patient has NO autonomy.
The patient tries hard to please the doctor and has NO active participation in their own treatment.
What is a GUIDANCE/CO-OPERATION relationship?
The physician still exercises much authority and the patient is obedient, BUT has a greater feeling of autonomy and participates somewhat more actively in the relationship.
What is a MUTUAL PARTICIPATION relationship?
The patient has greater participation in their care, in conjunction with the physician. This increases their feeling of personal autonomy.
What are the ADVANTAGES of the MUTUAL PARTICIPATION relationship?
1) Increasing their feeling of personal autonomy.
2) Patient adopts greater responsibility for their own health - sharing of information and decision-making.
3) Increased patient satisfaction - they have been fully informed and are less likely to complain about their care.
4) Can improve their compliance with medications/treatments.
Name 3 types of COMMUNICATION Skills exhibited by doctors during medical interviews
1) Content skills
2) Perceptual skills
3) Process skills
What are CONTENT Skills?
This is what the doctor wants to communicate to the patient.
In other words:
The substance of their questions and responses.
The information they gather and give.
The treatments they offer.
What are PERCEPTUAL Skills?
What the doctor is thinking and feeling.
In other words:
Their internal decision-making and clinical reasoning.
Their awareness of their own biases, attitudes and distractions.
What are PROCESS Skills?
How the doctor does something.
In other words:
The way doctors communicate with patients.
How they go about collecting a history or provide information.
The verbal and non-verbal cues they use.
The way they structure and organise communication.
Give some examples of GOVERNMENTAL ACTION to Promote Population Health
1) Legislation/Policies on Smoking/Alcohol (i.e. minimum age to buy products, licensing laws and taxation)
2) Improvements to Housing
3) Provision of Health Education
4) Health and Safety Laws
5) Traffic/Transport Legislation/Policies
6) Transport Policies, i.e. Cycle Lanes
7) Subsidise Healthy Food
8) Tax Unhealthy Foods
9) Ban Advertising on Unhealthy Foods
What is the World Health Organisation’s (WHO) definition of Health?
“Health is a state of complete physical, mental and social well-being and NOT merely in the absence of disease or infirmity”.
Name some LAY BELIEFS regarding “Good” Health
1) I have no existing illness/long term condition (LTC).
2) I exercise regularly.
3) I don’t take any routine medications.
4) I’m able to work, socialise and do everyday tasks.
5) I have a healthy diet.
6) I’m able to become pregnant.
What FACTORS INFLUENCE lay beliefs about health?
1) Age - older people equate health to functional ability; younger people equate health to physical strength and fitness
2) Social Class - people living in difficult economic and social circumstances regard health as functional
3) Gender - men and women think about health differently, i.e. women find it more interesting
4) Culture - different perceptions of illness/disease; different concordance with treatment
Name some HEALTH PROFESSIONALS
General Practitioner Staff Nurse Midwife Health Visitor Pharmacist Occupational Therapist Physiotherapist Dietician Speech and Language Therapist
What would be the ROLE of a GP in a patient’s care following pregnancy?
Postnatal examination
Follow-up examinations - 8 week baby check
Advice on immunisations
Care of any medical problems
What would be the ROLE of a Midwife postpartum?
Follow-up of mother and child for the first 10 days until school age
Advice on feeding - the advantages of breast feeding over formula use (i.e. the transference of endogenous antibodies to the new born)
What would be the ROLE of a Health Visitor postpartum?
Advice on early child care from 10 days old until school age
Information on immunisations
What would be the ROLE of a Pharmacist postpartum?
Advice on and supply of over-the-counter medication
Minor illness advice
Smoking cessation advice (if applicable)
Describe the STEPS involved in the Hypothetico-Deductive Reasoning process when making a diagnosis
1) History-taking - making several diagnostic hypotheses; drawing on past experience
2) Exclude rare/not immediately concerning diagnoses (rare, yet life-threatening, conditions must be actively excluded)
3) Seek to strengthen the case - adopt more detailed history-taking and examination; include some initial examinations
4) Extend the search if no diagnosis is found
5) If the patient does not follow the expected pattern of illness/recovery - revise the original diagnosis
Describe some SAFETY NETTING techniques
1) Advise the patient of the expected course of illness/recovery
2) Advise of the symptoms indicating deterioration
3) Advise as to who to contact in the event of a deterioration
Describe some other methods of MINIMISING RISK
1) “Chunk” and “Check” - summarise and verbally check that reasons for attendance are clear
2) “Hand over” (reiterate the fundamental points of the consultation to the patient at the end to ensure that all issues have been covered) and bring the consultation to a close
3) Deal with “Housekeeping” of recovery, and reflect, i.e. accurate and timely record keeping; referral if necessary; pause to reflect before the next patient
Name 4 ETHICAL PRINCIPLES which must be adhered to
1) Autonomy
2) Justice
3) Beneficence
4) Non-maleficence
What is meant by AUTONOMY for the patient?
A patient must be provided with all the facts about a treatment/trial and be allowed to decide for themselves if they wish to be treated (assuming they have the cognitive capacity to do so). For example, they should be informed of the risks associated with drugs that are still under trial, with minimal significant scientific evidence to corroborate their efficacy
What is meant by JUSTICE for the patient?
Ex) Patients should have equal rights to available treatments
What is meant by BENEFICENCE for a patient?
Ex) Any medication prescribed/administered must be given with a view to improving their condition
What is meant by NON-MALEFICENCE for a patient?
Ex) An awareness that medicine may harm patients in other ways, i.e. insufficient evidence may exist regarding the prevalence of adverse drug reactions for a particular medication
Give some examples of the use of COMPUTERS within GENERAL PRACTICE
1) Support prescribing
2) Patient records
Management of hospital letters
3) Management of blood tests/other results of investigations
4) Audit
5) E-consultations
6) Patient leaflets/resources
7) Public health information
8) Identification of patients for screening
9) To store appointments
10) To book appointments
What is the definition of a HAZARD?
Something that has the potential to cause harm
What is the definition of a RISK?
The likelihood of harm occurring
What QUESTIONS could be asked to ascertain if an OCCUPATIONAL RISK/HAZARD exists?
1) Does it happen at work?
2) Does it happen during the holidays?
3) Did it ever occur before you started working there?
4) Do you know of anyone at work who is similarly affected?
Name 2 CATEGORIES of COPING MECHANISMS for STRESS
1) Problem focused
2) Emotion focused
Give an example of a PROBLEM FOCUSED approach to COPING with STRESS
Enlist the help of family and friends to help with childcare
Give an example of a POSITIVE, EMOTION FOCUSED approach to COPING with STRESS
Seek counselling/stress management
Give an example of a NEGATIVE, EMOTION FOCUSED approach to COPING with STRESS
Alcohol or substance abuse
What aspects of LIFESTYLE would you advise patients to ALTER in order to have a healthier lifestyle?
1) Diet
2) Smoking Cessation
3) < Alcohol Intake
4) Exercise
5) Don’t use Illicit Drugs
6) Sexual Health Advice
As a GP, why might you be the most appropriate professional to GUIDE a young mother to be?
1) Knowledge of current and PMH
2) Awareness of their social circumstances, i.e. family support
3) Knowledge of broad range of illnesses and health conditions
4) Trusted health professional; likely to have been known to the patient/family for some time
5) GP has role in prevention as well as diagnosing/treating illness/disease, i.e. holistic care
6) GP likely to be local to the patient’s home and accessible
Other than ‘open-ended’ questions, list 4 other types of questions which may be used during consultation:
1) Direct - ask about specific items
2) Closed - “yes” or “no”
3) Leading - presumes the answer (best avoided)
4) Reflected - ask the patient to think about the answer themselves
List 4 FACTORS which would motivate a pregnant patient to change their behaviour and stop drinking.
1) Advantages outweigh the disadvantages, i.e. healthy baby
2) Anticipation of a positive response from others, i.e. family, partner and friends
3) Social pressure to change
4) Perception that this behaviour is in-line with their self-image
What is meant by CULTURAL COMPETENCE?
The ongoing capacity of healthcare systems, organisations and professionals to provide diverse populations with high quality care that is:
1) Safe
2) Person and/or Family Centred
3) Evidence-Based
4) Equitable
List some potential DIFFICULTIES that may arise when consulting a patient from a DIFFERENT CULTURE:
1) < Knowledge of NHS/UK healthcare system
2) Fear and Distrust
3) Racism
4) Bias and Ethnocentrism
5) Stereotyping
6) Language Barriers
7) Religious Beliefs
8) Presence of a 3rd Party, i.e. Family Member or Translator
List 3 different ROUTES via which someone can be exposed to a HAZARDOUS SUBSTANCE:
1) Blood
2) Inhalation
3) Ingestion
4) Sexual Contact
List some CATEGORIES of HAZARD in relation to working in a chemistry lab:
1) Physical - heat, noise, radiation from equipment
2) Mechanical - trips and slips
3) Biological - spread of infection
4) Psychological - anxiety regarding job security/deadlines/relationships with colleagues
The GP is often described as the “gatekeeper”, what is meant by this term?
A person who controls patients’ access (via referral) to specialist/secondary care
List some ADVANTAGES of GPs as GATEKEEPERS:
1) Identify those in need of secondary care
2) Personal Advocacy
3) Patient does not necessarily know which specialty to go to
4) > likelihood of referral
5) > likelihood of appropriate referral
6) < exposure to certain investigations
7) GP can provide patient education
8) Continuity of Care
List some aspects of HEALTH likely to be WORSE for CHILDREN living in DEPRIVED AREAS:
1) Low Birth Weight
2) < Benefit of Breast Feeding
3) Poor Dentition
4) > Rates of Obesity
5) > Likelihood of Smoking
What are some RISKS to FOETAL WELL-BEING?
1) Smoking
2) Illicit Drugs
3) Prescription Drugs
4) X-rays
5) Maternal Diet
6) Maternal Disease/Infection
7) OTC Medications/Internet Sourced Remedies
Define “CULTURE”:
Systems of Shared Ideas, Systems of Concepts, Rules and Meanings that Underlie and are Expressed in the Way the Human Beings Live
What are some of the COMMON REASONS for a CHILD in the UK seeing their GP?
1) Feeding Problems
2) URTIs
3) Rashes
4) Sore Throat
5) Vomiting + or - Diarrhoea
6) Abdominal Pain
7) Behavioural Problems
8) Developmental Delay
List some SOCIAL INFLUENCES on HEALTH:
1) Employment
2) Education
3) Finances/Income
4) Housing
5) Ethnicity
6) Environment
7) Social Class
8) Gender
9) Health System
What PERCENTAGE of ILLNESSES in the community are REFERRED onto SECONDARY CARE?
3% (2-5%)
What are some of the PHYSICAL EFFECTS that working OFFSHORE may have on an individual and their family?
1) Dangers of an oil rig
2) Adjustment to varying shift patterns
3) Potential for obesity due to abundance of food in the canteen
4) Fatigue due to long shifts
What are some of the PSYCHOLOGICAL EFFECTS that working OFFSHORE may have on an individual and their family?
1) Anxiety and Stress due to dangerous working environment
2) Anxiety due to security of employment in current economic climate
3) Uncertainty about returning home (weather delays)
4) Depression due to periods of isolation
What are some of the SOCIAL EFFECTS that working OFFSHORE may have on an individual and their family?
1) Discipline problems in children due to absent father figure
2) Substance misuse due to stress
3) No smoking or alcohol when offshore
What are some of the possible EFFECTS on an individual and their partner’s health caused by REDUNDANCY?
1) Anxiety about family’s future
2) Anger
3) Exhaustion due to need work extra hours to maintain family finances
4) Having to seek new employment
5) Stress at partner being home all of the time
If a patient attends a GP clinic and asks about the health of their partner, how should the GP respond?
1) Maintain the patient’s confidentiality
2) Maintain the patient’s trust
3) Consider GMC guidelines
4) Acknowledge the patient’s concern about their partner
5) Ask them why they are concerned
Define ‘ETHNICITY’:
1) Cultural practises and outlooks that characterise and distinguish certain people
2) Characteristics identifying an ethnic group which may include a common language, customs and beliefs and tradition
Define ‘RACE’:
A group of people linked by biological/genetic factors
List some of the different TYPES of SOCIAL CLASSES:
1) Professional
2) Managerial and Technical
3) Skilled - Non-Manual
4) Skilled - Manual
5) Partly Skilled
6) Unskilled
How does CULTURE influence SMOKING BEHAVIOUR in different social classes?
1) Lower social classes see larger numbers of smokers around them and are more likely to accept it as normal behaviour
2) Those around them more likely to accept the commencement of another individual smoking as normal behaviour (no social stigma)
What are the 3 MODELS of STRESS?
1) Engineering Model
2) Medico-Physiological Model
3) Psychological Model
Describe the ENGINEERING MODEL of stress:
1) Stress acts as a stimulus which the individual must resist
2) If the stimulus becomes too intense or prolonged, the individual breaks
Define ‘INCIDENCE’:
Number of new cases of a disease in a population in a specified period of time
Define ‘PREVALENCE’:
Number of people in a population with a specific disease at a single point in time or in a defined period of time
How can a doctor FACILITATE a conversation in a NONVERBAL MANNER?
1) Listening
2) Use of Silence
3) Posture
4) Body Language
5) Specific Gestures
6) Facial Expressions
7) Eye Contact
8) Layout of the Room
9) Staying in the Room
What are the DISADVANTAGES of GPs as GATEKEEPERS?
1) Stress on the GP to know everything
2) Referral may be hampered by bad doctor-patient relationship
3) > the time taken to see a specialist and receive treatment
4) Dissatisfied patients may inappropriately present to A&E or the private sectore
Approximately how many patients are registered on average with each GP in the NHS in the UK?
1200-2000 patients each
List some examples of what a GP COULD DO TO HELP individual patients:
1) Role Model
2) Prescribing
3) Tailored Advice
4) Referral
5) Arrange regular appointments
6) Patient Education
7) Tackle Underlying Causes
What is ‘STATISTICAL’ NORMALITY?
Based on the Normal Distribution Curve/Standard Deviation
What is ‘CULTURAL NORMALITY’?
Based on Norms and Values within a Certain Group, i.e. a Community
