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
