From consent onwards Flashcards
What is consent?
Voluntary agreement given by a competent patient that has been fully informed
What are the 3 requirements for valid consent?
Informed
Voluntary
Has capacity
What are the 4 forms of consent?
Oral
Written
Implied
Expressed
What information does the patient need as part of the consent process?
Potential benefits
Potential risks
Alternative treatment options
When is consent required?
Before examination Before treatment or care Before disclosure of confidential information For screening For teaching For research
Why is consent needed?
Helps trust between patient and doctor
Legal requirement
Respects autonomy
Professional duty
What is the Bolam Principle?
Practitioners are not negligent if they act in accordance with the practice accepted by a responsible body of medical opinion
What is negligence?
The concept of failure to exercise care
What is capacity?
Determined by a physician, refers to an assessment of the individuals ability to understand, appreciate and manipulate information to form rational decisions
What act focuses on who has capacity?
Mental capacity act 2005
Who does the mental capacity act apply to?
People over age 16
Which act says a 16 year old has full capacity?
The family law reform act 1969
What is Gillick competence?
A child under 16 can consent to medical treatment if deemed to be competent by a medical professional, without need for parental knowledge or consent
What is a POM?
Prescription only medicine
What is a P?
Pharmacy medicine- can get under pharmacist supervision
What are OTC drugs?
For sale over the counter, without any medical advice etc.
Why are P drugs used?
Pharmacists can ask customers questions about symptoms etc.
Ensures no red flags about how long the patient can use it for
Duration of symptom may mean its not safe to self-treat
Who regulates these medicines?
MHRA- medicines and healthcare regulatory authority
When can a POM change to a P?
When there is no danger when used correctly without doctor supervision
When can it go from a P to OTC?
When it can safely be used without pharmacy supervision
Name 4 community pharmacy schemes?
Minor ailment schemes
Emergency contraception
Smoking cessation
Health education
Self medication scale say patients fit into 3 main categories, what are they?
People reluctant to take analgesics
People who don’t think twice about taking analgesics
People who prefer to let pain run its course
What is quantitive data?
Discrete- only certain values possible
OR
Continuous- any value is possible
What is qualitative data?
Multinominal- categories aren't ordered OR Ordered- categories exhibit logical order OR Dichotomous- 2 categories that oppose
What are descriptive statistics?
Data is collected and summarised and described in terms of means, SD’s etc.
What is ecological fallacy?
Inferences about nature of individuals are deduced from inference for the group to which they belong
What are inferential statistics?
Using statistical tests to make generalisations about a population
What are nominal data, ordinal data and interval data?
Nominal- categorical e.g. sex
Ordinal- categories ordered in value e.g. degree of pain
Interval- continuous data with equal intervals e.g. age, height, weight
What are measure of locations with data?
Mean- average of all observations
Median- midpoint of the data set
Mode- Most frequent observation
What are measure of dispersion with data?
Standard deviation
Interquartile range
Range
What is a hypothesis?
An idea expressed in such a way that it can be tested and refuted
What is a null hypothesis?
The hypothesis that there is no difference between 2 groups
What is a P value?
The probability that the difference between groups would be as big or bigger than that observed if the null hypothesis is true
At what point is statistical significance generally accepted?
P=0.05- statistically significant, strong evidence against null hypothesis so can reject hypothesis
What is standard error?
Describes how good a given estimate is
Tells you how good your sample statistic is
Looks at how accurate your estimation of the mean is
What is a confidence interval?
Range of values that we think contain the mean, confidence limits are the actual upper and lower boundaries of this
Difference between race and ethnicity?
Race is genetic
Ethnicity is socially determined
Why is ethnicity important in medicine?
Disease prevalence varies with ethnicity
Best treatment may vary by ethnicity
Affects behaviour towards others
Can look at the patient according to their own values
What is ethnocentricity?
Judging 1 culture based on the values of another
What anaemia’s are genetic?
Sickle cell
Thalassaemia
What are the primary, secondary and tertiary management principles associated with sickle cell?
Primary- carrier screening
Secondary- Postnatal screening
Tertiary- treatment, preventative, therapeutics
How do we decide who to screen?
Cost- would cost a lot to screen everyone
Could be seen as racist to screen certain people and not other by race
How is ethnicity determined to know who to screen?
What is risk?
Probability that an event will occur during a specified time, only works if period is fixed
What is relative and absolute risk?
Absolute- risk of developing the disease over a time period
Relative- the ratio of the probability of developing an outcome in those exposed compared to those not exposed (risk ratio)
How to calculate risk ratio?
Risk in exposed divided by risk in non exposed
Risk ratio of 1 means no difference in risk between the 2 groups
Risk ratio of less than 1 means the risk is lower in experimental group than control group
What is absolute risk reduction?
Difference in risk between study and control populations
What is confidentiality?
Pledge of agreement to not divulge or disclose information about patients to others
Why is it important to maintain confidentiality?
Improves trust between patient and doctor Respects autonomy Prevents patient harm Virtuous Human rights act GMC requirement
When can confidentiality be breached?
Statute (law)
Consent by patient
Public best interest
Name some laws that oblige doctors to disclose information?
Public health act 1984
Road traffic act 1988
Prevention of terrorism act 1989
What is a cross-sectional survey?
Descriptive study, observational.
Analyses data from a population at 1 point in time
What is an ecological study?
Disease rates and exposures are measured in a series of populations and examined
What is a cohort study?
Prospective- have a group of people with or without risk factors and see if they develop a particular disease
What is a case control study?
Retrospective- have a group of people with a disease and look back to see if they had a certain risk factor e.g. if they smoked
What is a case report?
Detailed report of symptoms, signs, diagnosis, treatment and follow up of individual patient
What is a qualitative study?
Seeks to understand people’s perspectives and motivations
What is a randomised control trial?
Experiment where participants are randomly allocated into groups
Compare the experimental groups and control groups for outcomes
Why randomise trials?
Eliminates systematic bias
Basis for statistical tests
What types of bias are there in RCTs?
Selection bias
Ascertainment bias
Performance bias
What is temporal change?
People get better or worse irrespective of medical intervention
Hard to distinguish whether medical action or temporal change is responsible
What is regression towards the mean?
If a variable is extreme on its first measurement, it will tend to be closer to average on its second
What is statistical power?
The probability of rejecting a null hypothesis when it is false
What is a type 1 error?
False positive- rejecting null hypothesis when should have accepted it
What is a type 2 error?
False negative- accepting the null hypothesis when should have rejected it
