Foundations of Primary Care Flashcards
What is the most common cause of death today?
Cancer and Ischemic heart disease.
In young - accidents account for 38% in boys and 23% in girls.
Men age 15-34 suicide is main cause.
How much has life expectancy increased in Scotland since 1861?
- 3 years for men
34. 1 years for women
What is an unexpected death?
Sense of shock, no chance to say goodbye.
Accidents could be compounded by multiple deaths.
What is expected death?
Terminal care is the last phase of care when patients care is deteriorating.
Palliative care - WHERE AND WHO PERFORMS IT?
A philosophy of care that emphasises quality of life.
Is performed by a MDT.
Most provided in primary care with support from specialist practitioners and specialist palliative care units.
How do you know if a patient is at a palliative stage?
“Supportive and palliative care indicators tool”
Starts with anticipatory care planning.
What happens with palliative care patients in GP?
Practices have a register of palliative patients.
The practice team meet regularly to discuss the cases.
Enhances communication between team members.
OOH also notified of palliative cases.
What does WHO state that palliative care does?
Provides relief from pain and other distressing symptoms.
Affirms life and regards dying as a normal process.
Intends neither to hasten nor postpone death.
Integrates the psychological and spiritual aspects of patient care.
Offers a support system to help patients live as actively a possible until death.
Offers a support system to help the family cope during the patients illness and in their own bereavement.
Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated.
What is classed as a good death?
Pain-free.
Open acknowledgement of the imminence of death.
Death at home surrounded by family and friends.
An “aware” death, in which personal conflicts and unfinished business are resolved.
Manner that resonates with the person’s individuality.
What does the Gold Standard Framework offer?
Enable primary care to provide palliative care at home.
How do you break bad news?
Listen. Set the Scene. Find out what the patient understands. Find out how much the patient want to know. Share information using a common language. Review and summarise. Allow opportunities for questions. Agree follow up and support,
What can peoples reactions to bad news be?
Shock Anger Denial Relief Sadness Fear Guilt Anxiety Distress
What is Grief?
Individual experience.
Process that make take months or years.
Patients may need to be reassured that they are normal.
Abnormal or distorted reactions may need more help.
Bereavement is associated with morbidity and mortality.
What is Euthanasia?
“gentle or “easy” death.
The deliberate ending of a persons life without their request.
- Voluntary Euthanasia
- Non Voluntary Euthanasia
- Physician assisted suicide
- Patients request
- No request
- Physician provides the means and the advice for suicide.
What are the responses to people who want euthanasia?
Listen. Acknowledge the issue. Explore the reasons for the request. Explore ways of giving more control to the patient. Look for treatable problems. Remember spiritual issues. Admit powerlessness.
How do the GMC ensure that medical students have resilience?
They have specific training modules in their curriculum.
GMC work with medical students to promote regulatory requirements.
Continue to work to ensure its standpoint on recreational drug use and alcohol is communicated better.
What are some of the ways medical schools can promote well-being?
Delivering group learning exercises focusing on how to deal with stress.
Providing and promoting online resources on keeping healthy, including advise on healthy lifestyles.
Providing sessions on techniques such as mindfulness and meditation, and providing opportunities for physical exercise - manage stress levels.
What is the dictionary definition of Resilience?
The capacity to recover quickly from difficulties; toughness or the ability of a substance or object to spring back into shape; elasticity.
What are some of the other definitions of resilience?
Emotional competence or a personality characteristic that deals with negative effects of stress and promotes adaptation.
Can be acquired virtue or behaviour and requires continuous improvement.
Encompasses self-efficiency, self-control, self-regulation, planning and perserverance.
What are the personal strengths underpinning resilience?
High frustration tolerance Self acceptance Self belief Humour Perspective Curiosity Adaptability Meaning
What are the behaviours supporting resilience?
Building / having support networks - positive relationships. Reflective ability Assertiveness Avoiding procrastination Developing goals Time management Work- life balance.
What are the sources of burnout in terms of personal, professional and systemic?
Personal - Perfectionism, denial, avoidance, micromanaging, unwilling to seek help, being conscientious.
Professional - Culture of invulnerability, culture of presenteeism, blame culture/ silence.
Systemic - overwork, shiftwork, lack of oversight, chaotic work environments, lack of teamwork, fractured training.
What would highlight a struggling student?
Repeatedly failing or nearly failing Handing in work late Poor attendance Absence due to illness Behavioural issues Fitness to practice issues Lack of engagements with the course Poor communication with staff, peers and patients.
What factors aid resilience?
Intellectual interest - job satisfaction, career progression, variability, capacity to develop special interest.
Self awareness and self reflection - recognise and accept personal limits, establish boundaries in doctor-patient relationship, less self critical.
Time management and work life balance.
Continuing professional developing.
Support including team working - supportive relationships within and out-with medicine.
Mentors.
What else can affect resilience other than personal change?
Professional attitudes - changing sense of perfectionism, culture of silence, better support for those struggling.
Societal attitudes - changing culture of blame, reduce perceived threat of complaints, public acceptance of mistakes.
Structural changes - improved shift patterns, better work-life balance, less fractured training, regular breaks.
What is an occupational and environmental history?
Chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, exacerbated an existing health problem or has ill health had an impact on patients capacity to work.
What types of questions are asked in Occupational history?
Present and previous jobs from leaving school. Any exposure to chemicals. Symptoms improve when not at work? Duration and intensity. Personal protection used? Others in work place suffer similar? Known environmental hazards? Hobbies, overseas work?
What is a fit note?
Replace sick note in April 2010.
Facilitate earlier discussion about returning to work and about rehabilitation.
Items of consideration for employers when signing a patients return to work.
Only completed by a doctor.
Not binding on employer and does not affect statutory sick pay.
It is required if the patient has been off more than 7 consecutive days.
What do the occupational health services do?
Support and help people stay in work.
Prevent work-related ill health and provide specialist rehabilitation.
Provide independent, impartial advice to employers and employees on the effect of work on health and the effect of health on work.
Recommend appropriate adjustments in workplace.
Conduct research into work related health issues.
What are the options on a fit note?
Phased return to work - start with reduced hours each day.
Altered hours - work at different times of day.
Amended duties - change in work practice or content.
Workplace adaptation - changes to seating.
What are the effects of unemployment on health?
Higher mortality
Poorer general health, long-standing illness.
Poorer mental health, psychological distress.
Higher medical consultation.
Evidence that re-employment leads to improved self-esteem.
What is the dictionary definition of sustainability?
Ability to be able to continue over a period of time.
