HaDSoc Flashcards
Define healthcare quality
Safe - no needless deaths Effective - no needless pain Patient centred - No helplessness in those served or surving Timely - no wasted time Efficient - No wasted resources Equitable - No one left out
How do we know quality is not optimal?
Variations in health care provided
Problems of quality and saftey in healthcare?
Due to adverse events, many preventable.
“never events”
Describe theories about why patient saftey problems occur
Human error, culture and behavoir.
Systems do not plan and account for this.
Focus on short term fixes, encourages heroism, tolerates mistakes
How can a human based approach promote patient saftey and quality
Make things visible Use checklists Avoid reliance on vigilance Simplify and review processes Avoid reliance on memory Standardise common procedures and processes
Describe the swiss cheese model
Many holes so that hazards are not likely to lead to harm.
Some are active failures
Others are latent conditions, these are predisposing factors that make active failures more likely to happen e.g. training, design of equipment, staff
Need to set defences and barriers
Describe policies and oraganisations for encouraging quality in the NHS
Doctors work under clinical governance.
NHS has a legal duty to monitor and ensure quality and to continuous improve effectiveness of service and safty (follow NICE).
NHS outcomes framework feeds into guidance and standards. Linked to payment
Describe the NHS 5 domains of national outcomes
Prevent premature death
Ensure Qol for patients with ltcs.
Help people recover from ill health
Ensure patients have a good experience of care
Treat and care in safe environments and protect from harm
Purposes of NHS framework
Makes NHS accountable for money.
Provide info on how the NHS is performing
Act as a catalyst for driving up quality
Define clinical audit
A process that improves quallity through systematic review of care against criteria to bring about change
Describe NHS quality improvement mechanisms (7)
1 Standard setting- NICE evidence based.
2 clinical commissioning - quality through contracts
3 financial incentives- Qof and CQUIN (commissioning for quality and innovation)
4 disclosure - publically
5 Regulation - Care quality commission
6 clinical audit- local and national, standard setting, change, check
7 Professional regulation
Describe quality and outcomes framework (QoF)
Points generate income.
Areas include patient experience, clinical and organisational standards.
Describe CQUIN Commissioning for quality and innovation
Income based on meeting saftey, effectiveness and patient experience
What is clinical governance
NHS is responsible for ensuring continual improvement to quality of care, safeguarding high standards and creating an environment where excellence in clinical care can flourish.
Describe the benefits of systematic reviews e.g. cochrane library
Replace subjective narrative/ traditional reviews where it is unclear which studies were identified and the quality checks used.
Provide up to date conclusions for clinicians to save time.
Reduce time between discovery and implementation - easy to convert to guidelines
Identify gaps in research
Describe quantitative research methods and the positives
Collection of numerical data. Begins with idea/ hypothesis allows conclusions to be drawn. Can be analysed, repeated, reliable.
E.g. RCT, case control, questionaires, secondary of other research.
Used to find relationships and draw conclusions, allowing comparisons, measuring and describing.
Describe the negatives to quantitative research
Quantitative methods e.g. questionairs, may force people into categories, not collect all data/ important info, may not establish causality
Describe questionnaire use
Quantitative. Measure satisfaction, attitudes or individual exposures.
Should be valid (measure what it should) and reliable (variation comes from participants).
Boxes or questions (but need to be fitted into categories)
Self completed or administered.
Uses for qualitative
Make sense of phenomena
Understand peoples views and behaviours
Emphasise meaning, experience and views of respondents
Analysis is subjective
4 types of qualitative research
Ethnography and observation
Interviews
Focus groups
Documentary and media analysis
Describe ethnography and observation
study of people and culture.
May be participant observation or non-participant observation. People may not be aware of things or think its not worth commenting. Can be labour intensive
Describe interviews
qualiative.
Semi structures, agenda of topics and prompt guide but conversational in style.
Emphasis on participants views with interviewer facilitating
Describe focus groups
Flexible - qiuickly establish parameters and collective understanding.
Encourages participation
May inhibit deviant views.
Not good for individual views
Needs homogenous group, good facilitator and may be difficult to arrange.
Some topics may be too sensitive.
Describe documentary and media analysis
Uses independent evidence -gets inside view for topics hard to research/ investigate.
Provide historical context
Describe analysis of qualitative data
Labour intensive. Inductive approach: Close inspection Identify themes Specification for themes Assign data to themes Compare data against themes
Positives and negatives to qualitative data
Positives:
Access info not revealed by quantitative
Understand perspectives
Explain relationships between variables.
Negatives:
Generalisability - one view is not representative, left with many
Finding consistent relationships between variables.
Describe audit in qualitative research
Must be transparent and robust.
Lots of tools e.g. CASP - rigour, credibility and relevance.
Good research has lots of audit
What is evidence based practice
The integration of individual clinical expertise with the best available external clinical evidence from systematic research
Give practical criticisms of evidence based medicine
RCTs are not always possible/ ethical
Expensive to create and maintain systematic reviews for all specialities
Challenging and expensive to implement findings
Requires good faith from pharma companies.
Philosophical critiques of evidence based medicine
Does not align with most doctors’ modes of reasoning (probabilistic vs deterministic)
Unreflective rule followers are created
Population level outcomes doesnt mean an intervention will work for a patient
Professional autonomy
Legitamising rationing - undermine patient-doctor relationship
Difficulties of getting evidence into practice
Doctors arn’t aware of evidence
Know but don’t use e.g. culture, habit, professional judgement.
Funding
Lack of resources
Organisation cannot support - managers lack clout to invoke changes
Commissioning decisions reflect different priorities
What is NS-SEC
National statistics socioeconomic classification. 1-7. Lower the score then the better an individual’s health
6 reasons for diversity in health from the black report
1 artefact
2 social selection - people who are healthier can get better jobs
3 Behavioural cultural. Poor backgrounds tend to engage in less healthy behaviours
4 materialist - lower resources so lack of choice in exposure to hazards
5 Psychological - (whitehall studies)- social graient of factors. Job security, support, neg life events, autonomy at work, stress.
6 income diversity - countries with greater inequalities
Difference between inequality and inequlity
Inequality - two things arnt equal (different
Inequity - inequality that is unfair or avoidable
What do utilisation studies find in more deprived areas and why?
More GP use
More emergency
Underuse specialist and preventative
Normalisation of ill health (managed as a series of crises) and lack of resources to change this, lack of cultural alignment,
Explain why understanding lay beliefs are important in medical practice
Gaps between lay beliefs and medical knowledge. Affects behaviours and compliance. Definitions of health and illness vary
What are the different perceptions/ definitions of health
Negative: Absence of illness
Functional: Ability to do things
Positive: state of wellbeing and fitness
Higher socioeconomic tend to be positive
Where do lay beliefs origninate
Social, cultural, personal knowlege and experience.
Answers how and why. Public is surrounded by medical concepts but interpret them differently.
What is health behaviour
Activity undertaken to maintain health and prevent illness
What is an illness behaviour
Activity done in ill health to define illness and seek solution e.g. acceptors, pragmatitists
What is a sick role behaviour
Formal response to symptoms including seeking formal help and action of person as a patient e.g. take meds
What is the lay referral system
People seek advice from other lay people before or instead of seeking professional advice
Why is lay referral system important
Explains why and when patients present, explains use of services and medication
Determinants of illness behaviour
Culture Threshold for tolerance Visability of symptoms Information and understanding Availability of resources Lay referal Disruption of life
Describe the determinants of health and disease
Physical environment
Socio economic environment
Individual genetics, characteristics and behaviour
Describe the prociples of health promotion
emancipation Participatory Holistic Intersectoral - many agencies involved Equitable Sustainable Multi-strateg
Define health promotion
Enable people to improve control over their own health
Difference between health promotion and public health
Public health focuses on ends.
=Health promotion (individuals to help themselves) + health protection (agencies help people)
Health promotion = health education x health public policy
Give the sociological critiques of public health
1 Structural - material conditions cause ill health - focus on individual responsibility
2 Surveillance critiques
3 consumption critiques - lifestyle choice arnt just health risks but are tied up to identity
Give the 5 approaches to health promotion
Medical and preventative Behavioural Education Empowerment Social change MBEES
Describe primary prevention and give its 4 approaches
Reducing exposure to risk factors to prevent onset:
Immunisations
Take necessary precautions
Avoid environmental risk factor
Reduce risk from health related behaviours
Describe secondary prevention
Prevent progression of a disease - detect and treat at earliest stage e.g. screening,, treating BP
Describe tertiary prevention
Minimise the effects of an established disease e.g. maximise capabilities of patient
State the dilemmas raised by health promotion
Ethics of interfering in peoples lives Victim blaming Prevention paradox Unequal distribution of responsibilty Fallacy of empowerment Reinforces negative stereotypes
Issue of interfering in peoples lives
Psychological impact
Rights and choices affected by state intervention
Issue of victim blaming
Plays down impact of wider socioeconomic and environmental determinants e.g. cost
issue of fallacy of empowerment
Giving info does not give power.
Unhealthiness not due to ignorance but adverse circumstances
Issue of reinforcing negative stereotypes
targeting drug users and HIV
Issue of unequal distribution of responsibility
Healthy behaviours often left for women e.g. buying veg
Issue of the prevention paradox
Difference for population but not much difference on individual level - may think they are not a candidate
Health promoters must engage in lay beliefs
Define evaluation
The rigorous and systemic review of the effectiveness of a program in achieving predetermined objectives
Why evaluate?
Accountability - politics, legitimacy to interventions Programme management and development Ethical obligation - no harm Evidence based interventions APEE
Describe the types of health promotion evaluation
Process - qualitative, ‘formative’ or ‘illuminative’, assess the implementation
Impact - initial, easiest to do
Outcomes - subject to delay and decay, hard to measure as many conflicting/ confounding factors, expensive
Describe evaluation difficulties
Design of the intervention
Lag time
High cost
Other confounding factors
What is the sociological approach to ltc?
Understanding illness’ affect on social relationships and role performance.
Concerned with experiences and meaning.
How people manage their everyday lives
What are illness naratives
Accounts of experiences of ltc, make sense of illness
What is the impact of getting a diagnosis?
Remove uncertainty around time of diagnosis (some ambivalent diagnoses can be unpleasant).
Can be a shock, a relief or very threatening.
Describe the work of chronic illness
Ilness work Everday life work Emotional work Biographical work Identity work
Describe illness work
Managing symptoms.
Describe everyday life work
Planning life and social interactions based on illness.
Coping and strategic management. e.g. mobility of resources, balance demands and remain independent.
Try to seem normal or create new identity
Describe emotional work
Protect the emotional weelbeing of others e.g. seem cheery.
Deliberately maintain normal activities and relationships.
Down play pain.
Impacts role e.g. breadwinner. Dependence leads to feelings of uselessness.
Describe biographical work
Loss of self.
hard to lead a valued life.
Former self image crumbled without an equally valued replacement.
Concious of fragility of life, grief for former life.
Abnormal biological trajectory to deal with
Describe identity work. the 4 dilemmas
Connotations of conditions affect how people see themselves and how others see them (or imagined). can become defining aspect.
4 dilemas of loss of self:
Scrutinise other’s reactions
Dependence on others (straigns relationship)
Relationships harder to maintain, requires more intimate contact.
Inability to do - loss of social life.
What is stigma
a negative defined condition, attribute or behaviour conferring deviant status.
What is the difference between discreditable and discredited stigma
Discreditable stigma - something that if found out would have stigma e.g. HIV/ mental health
Discredited stigma - physical/ visbile characteristic that us well known
What is the difference between felt and enacted stigma?
Enacted - the experience of prejudice, discrimination and disadvantage due to stigma
Felt - the fear of enacted stigma - shame - selective concealment
What is narrative reconstruction?
People reconstruct their new identities in ways that explain their illness. Creates coherence, stability e.g. RA and carrying someone.
Describe the issues with self managaement interventions and LTCs
Adherence is poor, reduced QoL, Poor psychiological wellbeing.
Brief interventions may work e.g. online, telephone but vary in qality and effectiveness
Describe positives and negatives to the expert patient programme
Pos: Patient focused Skills in management and coping, aim to reduce hospital admissions Neg: Responsibility on ill patients leading Little evidence for efficiency saving real agency and understanding?
Describe the medical model of disability and give critiques
Disadvantages are a result of an impairment/ disability.
Disability is variation from medical norm.
Needs medical intervention to cure/ help.
Lack of recognitiion of social and psychological factors, stereotyping and stigmatising
Describe the social model of disability and give critiques
Disability is failure of environement to adjust, a form of social oppression.
Political action and social change needed.
Failure to recognise realities and the extent to which these are solvable. Body is left out
Give the international classification of impairments, disabilities or handicaps (ICIDH)
Impairment - abnormalities in functioning and structure of body
Disability - Loss of ability to participate in activities
Handicap - Broader social and psychological disadvantages/ impacts of an impairment e.g. cant get a job
Problems with ICIDH
Handicap is used derogatorily.
Implies problems are inevitable.
Manly medical model
Key components of ICIDH
Body structure and function Activities Particpation (restrictions)
Why is Hrqol valuable?
Implications for cost Indication for need of healthcare Assess effectiveness of treatment evaluate quality of health care Monitor progress
Different tools for measureing HRQoL
Mortality, morbidity, patient based outcomes
Describe mortality as a measure of HRQoL
Easy to collect
Inacuracies
Not good for assessing outcomes and QoL
Describe morbidity as a measure of HRQoL
Easy to collect e.g. registers
Not always accurate
Nothing about outcomes
Describe patient based outcomes and their uses
Patient reported outcome measure (PROM). More people with ltcs, need to focus on concerns as biomedical tests are only one part of picture. may be iatrogenic damage.
Patient based outcomes can:
• They can be used clinically
• Br udrd to assess benefits in relation to cost
• Be used in clinical audit
• Be used to measure health status of populations
• Be used to compare interventions in a clinical trial
• Be used as a measure of service quality
What are the challenges of using PROMS
Participation
Cheaply and effectively undertaking and presenting results
Expanding to all areas of medicine
Avoid misuse
What is HRQoL?
Functional effect of an illness and its treatment on a patient as the patient sees it.
Describe the different components of HRQoL
Physical function Symptoms Global judgement Psychological situation Social situation Cognitive functioning Personal constructs e.g. satisfaction with appearence, stigma and life. Satisfaction with care
Describe qualitative methods of measuring HRQoL
Access to some unique parts
Hard to evaluate
Costly and timely.
Can be generic (questions on all areas e.g. social, emotional, and for overall health) or specific
Important parts to measuring PROM
Reliability - consistent results, accurate over time
Validity - measure what it is supposed to measure
So can measure across different groups and compare.
Give examples of generic measures of HRQoL
Short Form 36 item questionanaire (SF-36) The EuroQol (EQ-5D)
Advantages to generic instruments
Broad range, not disease specific, detect unexplained effects of an intervention
Can assess health of whole pop
Disadvantages to generic instruments
No good for specifics too general
Less sensitive to changes
Less acceptable to patients
Describe SF 36
36 items in 8 sections: Physical functioning Social functioning Role functioning (physical) Role functioning (social) Bodily pain Vitality General health Mental health
Describe EQ-5D
5 dimensions Mobility Self care Usual activities Pain/ discomfort Anxiety/ depression
Positives of SF 36
Quick for patients
Reliable and valid
Widely used in research
Responsive to change Pop data available
Positives of EuroQoL
Particularly good in economic
good reliability and validity
Describe specific instruments
Disease specifiic
Site specific
Dimension specific e.g. pain
Advantages and disadvantages to specific instriments
Advantages:
Applicable to patient
Sensitive to change
Relevent content
Disadvntages:
May not detect everything
Comparison is limited
Must have disease
How to select a HRQoL measure?
Work showing reliability and validity Previous use Suitable? Adequately reflect patient concerns Acceptable to patients? Sensitive to change? Easy to administer and analyse
How is disease detected?
Opportunistic finding, screening or spontaneous presentation
Define diagnosis
Definitive identification of a disease through examination, investigations or other measn to label someone as either having a disease or not
Define screening
The systematic testing in an easy and cheap way to distinguish between apparently well people who probably have the disease and probably do not.
List the criteria for implementing a screening programme: 4 areas
Disease
Test
Treatment
Programme
List the criteria for implementing a screening programme Disease/ condition
Must be important prob
Well understood eitiology and natural history
Early detectable stage
Primary prevention must have been tried
List the criteria for implementing a screening programme relating to the test
Acceptable to patient Cheap and effective Simple and safe Precise and valid An agreed cut off Agreement on who to investigate further Specificity, sensitivity, PPV, NPV
What is sensitivity
If I have the disease what are the chances it will be detected? True postives/ TP +FN
What is specificity
If I dont have the disease what are the chances that i will be correctly identified as not having the disease? TN/ TN+FP
What is a positive predicted value? what is it affected by?
If i screen postive what are the chances I have the disease? TP/ TP+FN. Affected by prevalence
What is a negative predicted value?
If I screen negative what are the chances I dont have the disease? TN/ TN+FP
Consenquences of false positives
Stress and anxiety of diagnosis. Invasive tests. may affect future uptake of screening
Implications of false negatives
Inappropriate reassurance, may delay actual diagnosis
List the criteria for implementing a screening programme relating to the treatment
Evidence based treatment available
Early treatment must be beneficial
Agreed policy on who to treat
Optimise management before screening
List the criteria for implementing a screening programme relating to the programme
Oppotunity cost Proven effectiveness RCT Quality assurange for whole process Diagnosis and treatment facilities Councelling facilities Other options considered? e.g. improve treatment Parameter should be justifiable to the public Benefit outweighs harm from proceedures
Briefly list the disadvantages of screening
1 Alteration of doctor-patient contract. Normally patient indentifies themselves, not the other way around
2 Complexity of screening programs. Is it working? Overdiagnosis? Psychological impact?
3 Evaluation of screening
Based on good quality evidence. Lag time bias - (early diagnosis so appear to survive longer?) and length time bias (only slow ones detected so sees better outcomes) Selection bias - healthy volunteer effect
4 Limitations of screening
False post and neg. May not fully treat. Informed choice as it may harm
5 sociological critiques
Describe the sociological critiques of screening
Victim blaming
Individualising pathology
Populations increasingly subject to surveillance
Screening is a form of social control
Health and illness practices can be seen as moral through social relationships..
Screening targeted at women than men
Screening programms in the UK
Cervical cancer. - cervical smear, abnormal cells. 25-65 different time periods. HPV incorporated. However, is the disease (all aspect) well understood and its impact? Right women? Over-treatment? ect
Outline a brief history of the NHS
Estabished to provide, comprehensive, universal and free healthcare.
Changes in 40s and 50s overwhat constitutes a health need.
80s more mangers
Increasing marketisation of provision
Describe the current structure and functions of the NHS in England
Sos- NHS England - regional bodies - CCGs - Hospitals, mental health
Sos - NHS England - GPs, dentists, specialist/ national services
What is a national tariff?
A minimum amount that can be paid for a service. Forces providers to compete in quality not just price.
Describe the health and social care act 2012
Created CCGs, devolves power to GPs. Opportunity for social enterprises. Trying to make £20 billion efficiency saving per year
Describe management roles of doctors
GPs can become partners. Responsible for flow of money and management of finite resources. Leadership, decision making and contract management.
Medical director - job descriptions, staff management, medical quality, implement change.
Clinical director - For a speciality, responsible for directorate. Medical education, new policies, audit, guidelines.
Consultant - responsible for team
GP
Role of Sos and Department of health and NHS England
SOs- overall accountability for NHS
Department of health - sets national standards, national tariffs and sets direction.
NHS Eng - authorises CCGs, commissions primary care, supports commisioning
Descrube 4 parts of management skills
Strategic (plan and decide), financial, operational, HR
Explain the inevitability of rationing in health care systems
Finite resources
Increasing demand due to ageing population and consumerism.
Increased costs due to new technologies, treatments and LTCs.
Gives a deterrent
Describe explicit rationing
Defined rules of entitlement.
Systematic allocation of resources.
Decisions and reasons are explicit.
Political and technical process.
Advantages of explicit rationing
Transparent. Open for debate, fair, accountable, evidence based
Disadvantages of explicit ratioing
Complex, heterogeneity of patients and illness. Patient and professional hostility, threat to freedom, patient distress
Describe implicit rationing
Care is limitied but decisions made are not clearly expressed.
Allocation through individual clinical decisions without explicit criteria.
Advantages of implicit rationing
Sensitivity to the complexity of medical and patient needs
Disadvantages of implicit rationing
Inequalities and discrimination. Open to abuse, social deservingness
Describe rationing in the NHS 5Ds
deterrent e.g. perscription charges, delay, deflection, dilution and denial
What is a healthcare resource group?
A set group of similar treatments which require a similar amount of resources. The higher the HRG then the higher the tariff paid. Organisations can make profits/ losses in this way. No pay for never events. Unit of currency
Desribe the basic concepts in health economics
Scarcity, Effectiveness, Equibility, Utility (how much patients value it), equity, efficiency and opportunity cost
Describe opportunity cost
Cost of benefits foregone. Value of the next best alternative.
What is technical efficiency
the most efficient way of meeting a need
What is allocative efficiency
Choosing between the many needs to be met
How do we measure cost of a treatment?
Cost of health care services, patient time, treatment, cost of care giving, economic cost to patient (employers).
How do we measure benefits of a treatment
Mortality, QoL, economic benefit of individual/ family members, savings in other resources.
How can economic assumptions/ costings be checked
Sensitivity analysis
How is the delay taken for the benefits of a treatment measured and calculated
Discounting, values of inputs and outcomes in the future
What are the 4 types of economic evaluation?
Cost minimisation analysis, cost benefit analysis, cost utility analysis, cost effectiveness analysis
Describe cost minimisation analysis
Two treatments with outcomes assumed to be equal. Choose lowest cost
Describe cost effectiveness analysis
Common health outcome. Measure in cost per health unit outcome e.g. BP
Describe cost benefit analysis
Calculate costs of treatment and benefit (inputs and outputs). Choose overall cheapest. Does not account for improved QoL
Cost utility analysis
Focused on quality of health outcomes produced or foregone e.g. QALY
How are QALYs calculated?
HR-QoL assessed via the EQ-5D.
How does NICE allocate resources
Technology appraisal on cost effectiveness and clinical effectiveness.
Process.
-ID of topics - DoH, patients, carers, public
-Scoping- NICE/ DoG
-Assessment - HTA (health technology assesment) assessment groups
-Appraisal
Measures treatments based on QALY and ICER
What is the incremental cost-effectiveness ratio (ICER)? How is it used
Cost per QALY to determine cost effectiveness = ICER. Below 20k fine. 20-30k- analysis. 30k needs a stronger cse
Describe flaws in QALY
Technical problems with calc. May not distribute based on needs. RCTs not perfect. PCTs have less money for other priorities Political interference?
Describe the policy background to the growth of interest in patients’ views of health services
In 2000, The NHS plan emphasising organising care around the patients. Involving patients in healthcare (from Bristol enquiry).
2006 - Duty of PCTs to involve and consult patients and public in planning services and decisions.
NHS Outcomes framework
Why? Patient satisfaction is an important outcome, increased external regulation, secures legitimacy.
Describe the role of HealthWatch England (and local healthwatch)
A consumer champion.
Can enter, view and influence services, produce reports, provide info and support to local services
Deascribe ways patients have to give feedback
NHS friends and family test.
NHS choices - comment and rate
Describe PALS
Patient advice and liason service. Health related questions Resolve concerns within NHS Advice on complaints Info about NHS
Describe the parliamentary and health service ombudsman
Independent view of unresolved complaints. Investigates
Problems with compliants
Lack of info available
Lack of confidence in a resolution
System complexity and confusion
No feedback
How are patient’s views investigated?
Indirectly - patient complaints and ombudsman
Directly - quantitative (more common as easier and annonymous) and qualitative (what priorities are) methods
Some DIY-locally developed and some national
What causes patient dissatisfaction?
Poor communication/ interpersonal skills. Not full histories, not all concerns, no reassurance, no appropriate advice.
Content of healthcare- hygiene, inconvienience ‘hotel’ aspects
Give sociological aproaches to the patient-proffessional relationship
Functionalism - consensus and reciprocity
Conflict theory - emphasises conflict
Interpretivism/ interactionism - emphasise meaning given to social situation
Patient -centred/ partnership
Describe the functionalist approach to patient-proffesional relationships
2 different roles - unequal. Powerful vs vulnerable.
Social equilibrium restored by work of medicine.
Sickrole and doctors role according to functionalists
Sickrole = helplessness/ dependence - should want to get well and not abuse rights, expected to seek out help Doctor = Benefit the patient, no self interest, objective (nondiscrimmatory), intimate patient access, autonomy, financial reward
Critisisms of the functionalist approach
Sickrole- some cant get better, legitimate and illegitamate occupants of sick role?
Assumes patient has passive role
Assume rationality and benefice of medicine
Doesnt explain why things go wrong
Conflict approach to the doctor-patient relationship
Doctors hold bureaucratic power-gatekeeper
Monopoly on defining health
Patient has little choice.
Lay ideas are suppressed and discounted.
Medicine can pathologise aspects of social life.
Cultural iatrogenesis due to dependency on medicine and loss of self reliance.
Medicalisation of child birth-loss of control for women
Criticisms of the conflict approach
Inenvitable conflict accurate?
Patients can exert control e.g. nonadherence
Patients can medacalise issues too
Patients can assert themeselves in consultations
Explain interpretive/ interactionist approaches
Focused in the meanings both parties give to the consultation. How does order emerge through interaction? informal unwritten rules/
explain patient centered models
More cooperative and less hierarchial if patient views taken seriously. Egalitarian Underpins recent policy. ICE - seeks understanding of patient's world. Mutual agreed management Enhance prevention and health promotion Good relationship Shared decision making
Describe the professionalisation of medicine
Started as elite - not science but status
Only for rich.
GMC in 1800s for registration of doctors - controlled entry and removal of registration.
Self regulation
Describe evidence and theory about socialisation of doctors into the medical profession
Individuals internalising and cooperating with collective norms of the professional grop and alligning their conduct with professional standards.
Through medical education, learning values and attidues, orientations to patients and others.
Informal and formal corriculum.
Used to be assumed by GMC is competent
Assess critically different approaches to the regulation of doctos
Self regulation - Self serving and strategic, comfortable occupation, promoted a false vision of objectivity and reliability, autonomy led to insularity and mistaken arrogance about mission. Whistle blowers discourage and disbelieved. Poor discipline. failure of regulation. Etiquette not to monitor other doctors.
Managerialism - less clinical autonomy
Describe sociological theory and evidence on healthcare organisations
GMC became moredemocratic and became more regulatory due to enquiries. Revalidation included, Setting standards, move away from self regulation.
After 2007 white paper - lay members included and regulated itself.
What is a proffession, professional and professionalisation
Profession - a type of ocupation able to make distinctive claims about its work and practices
A professional is a member of a profession.
Professionalisation is the social and historical process of an occupation becoming a profession (Exclusive claim over knowledge, control over mark and exclusion of competitors, control over professional workpalce).
Describe ftp
By the medical practitioners tribunal service (MPTS) due to illness, practice or convictions. Also failings in: Apologising Listening to concerns Reporting others mistakes Working collaboratively
Describe licensing and revalidation
based on good medical practice.
Positi ve affirmation, maintain and improve practice.
Encourage feedback
Give support
Clinical governance.
Three steps:
Annual appraisals in the work place
Portfolio
Positive recommendation from a responsible officer (for dealing with performace and GMC).
Requires evidence e.g. feedback and activity
Describe the role of managerialism
implementation of policies, comply with guidelines
Administration and management
Clinical excellence awards
