Foundations of Primary Care Flashcards
Aspects of healthy lifestyle
Sexual health, diet, exercise, alcohol, smoking, illicit drug use
Advantages of position of GP
Aware of current and past medical history. Aware of social circumstances. Broad range of knowledge. Trusted health professional who has long term relationship with patient. Responsible for holistic care. GP is accessible to patients.
Types of question
Open question. Direct question. Leading question. Closed question. Reflective question.
Motivators to change behaviour
Believe change is possible in all situations, advantages of changing outweighs advantages of not changing, change is socially acceptable, anticipation of positive response from friends/family . New behaviour consilient with self-image.
WHO definition of health
State of complete mental, physical, and social wellbeing and not merely the absence of disease and infirmity.
Lay beliefs on health
Social class, gender, age and culture
Government control of health
Funding of health service, vaccination programmes, legislation, public transport policies, exercise facilities, increasing tax on unhealthy foods/subsidising health options , health education, control of advertising, health and safety laws, housing improvements
Cultural competence
Ongoing capacity of healthcare systems, organisations and professionals to provide diverse patient populations high quality care that if safe, patient and family centred, evidence based and equitable.
Difficulties between cultures
Language barrier, different expectations, presence of third party (translator/family member), racism or prejudice, different beliefs regarding health, religious beliefs, lack of knowledge of NHS, fear and distrust, examinations taboos, gender difference between Dr and patient, patient not entitled to NHS care
Routes of exposure to hazards
physical contact, inhalation, blood, sexual contact, ingestion
Categories of hazard
Chemical, physical, mechanical, psychological, biological
Safety netting
Explain expected course of illness/recovery, explain symptoms that indicate deterioration, explain where to go/who to contact if patient deteriorates
Ways in which risk can be minimised in a consultation
Summarising and verbally checking reason for attendance is clear.
Handing over to patients and bringing consultation to a close, insuring all issues have been covered.
Deal with housekeeping of recovery and reflection (record keeping, referral if necessary and reflecting before seeing next patient)
Definition of gatekeeper
Controls access of patients to secondary care in the NHS
Advantages of GPs as gatekeepers
Identifies patient in need pf specialist care.
Increases likelihood patient sees correct specialist.
Patient may not know which specialist they require to see.
Saves resources as only patients who require specialist care receive it.
Patient not exposed to radiation/procedures needlessly.
GP acts as coordinator of care.
Opportunity for GP to provide patient education.
Percentage of illnesses occurring in the community that are referred on to secondary care.
3%
Health and social care team members
Pharmacist - minor illness advice and medication advice.
Physiotherapist - helps with patient recovery and mobilisation of patients.
Practice nurse - blood tests
Dietician - assessment of nutrition and advice on weight gain/loss
Counsellor - assess and manage mood
Practice nurse - assessment and advice on long term conditions, blood tests and vaccinations
Occupational therapist - assess for aids to assist daily living
Midwife - follow up first 10 days after birth and advice on feeding
Health visitor - early child care advice until school age and immunisations
Ethical principles
Autonomy - patient control of their own care
Justice - all resources available for everyone
Benefice - help the patient
Non-malefeince - do not harm the patient
Ethical issues surrounding health
Beliefs, religious beliefs, thoughts on your capacity
Psychological issues surrounding health
Anxiety about a treatment, anxiety about consequences of a health issue, stress/anxiety about level of support from family
Social issues surrounding health
Does support network exist, effects on social life, ability to find a job
Styles of doctor patient relationship
Mutual participation, Authoritarian or paternalistic, Guidance/co-opaeration
Mutual participation style relationship
Patient has greater role in care so feels greater sense of personal autonomy.
Patient has greater responsibility for the their own health through sharing info and decision making.
Patient is more satisfied with consultation where they have been fully informed.
Patient may be more complaint with advice/treatment.
Authoritarian or paternalistic relationship
Dr has all the authority inherent in their status and patient has no autonomy. Patient tries to please Dr and does not actively participate in own treatment.
Guidance/co-operation relationship
Dr still exercises much authority and patient is obedient but patient has greater feeling of autonomy and participates more actively in relationship.
Communication skills
Content skills, perceptual skills and process skills
Content skills
What Drs communicate - substance of questions and responses, info they gather and give and treatment plans
Perceptual skills
Drs internal decision making, clinical reasoning, awareness of own biases, attitudes and distractions
Process skills
Way that Drs communicate with patients, how they go about discovery history or providing info (verbal and non-verbal skills - way they structure and organise communication)
Factors that influence views on behaviour
What is normal for peer/social group
What is shown on TV/social media
Hypothetico-deductive reasoning process
Several diagnosis generated from Dr experience based on history
Rare and not immediately concerning diagnosis can be excluded at early state
Rare but serious diseases should be actively excluded
More detailed history and examination to strengthen case for diagnosis/diagnoses
Extend search if no diagnosis identified
Revision of diagnoses required if patient does not follow expected course/pattern of diagnosis
Process is about finding the most likely diagnosis (not necessarily most common)
Role of computers in general practice
Store and book appointments Store patient records Support prescribing Electronic management of hospital letters Electronic management of test results Useful in conducting audits Chronic disease management and recall E-consultations Patient leaflets/resources Public health info Identify patients for screening programmes
Hazard
Something with potential to cause harm
Risk
The likelihood of a hazard occurring
Questions to determine if illness is occupational
Does it happen at work?
Does it happen at holidays?
Did it occur before starting to work there?
Is anyone else at work effected?
Coping mechanisms for stress
Problem focused - make problem causing stress better/easier
Emotion focused - counselling or stress management (or alcohol and drug misuse - negative)
Problems of child health in deprived areas
Lower birth weight
Less likely to benefit from breast feeding
Poorer dental health
Higher rates of obesity and poor nutrition
Higher rates of teenage pregnancy
More likely to take up smoking, alcohol misuse or substance misuse.
Greater risk of admission to hospital
Greater risk of infant mortality
Less likely to get vaccinations
Risks to foetal wellbeing
Smoking, illicit drug use, prescription drugs, OTC medication, herbal medication, X-rays, diet (poor nutrition, lack of folic acid), infectious diseases, maternal disease
Tilar definition of Culture
A complex whole which includes knowledge, beliefs, art, morals, law, customs etc.
Common reasons for children seeing GP
Pyrexia, feeding problems, URTIs/colds, coughs, sore throat, vomiting and/or diarrhoea, abdominal pain, behavioural problems, anxiety
Social influences on health
Gender, ethnicity, housing, employment, financial security, health system, environment, social class
Non-verbal communication
Listening, use of silence, posture, body language, specific gestures, facial expressions, eye contact, layout of room
Disadvantages of GPs as gatekeepers
Patients have less choice in secondary care
Places stress on GP to have wide range of knowledge, Dependant on individual GP knowledge, attitudes and skills.
Increased time to see specialist and receive treatment
Dissatisfied patients may inappropriately present to A&E or private sector
No of patients registered with a GP
1200-2000
Keesing definition of Culture
Systems of shared ideas, concepts, rules and meanings that underlie and are expressed in the way human beings live.
