HBS 27-34 Flashcards
Do we think logically? No. So what are the two ways of thinking?
System 1: Fast, unconscious, intuitive, minimal effort, heuristics.
System 2: Conscious, deductive, slower, analytical, requires effort.
Diagnostic error
A diagnosis that is missed, wrong, or late.
Misdiagnosis-related harm
Preventable harm that occurs from delay of treatment, or from treatment for a condition that was not actually present.
Medical diagnosing; hypothesis testing:
Hypothesis are established tested to be disproved. If they fail they are replaced by further hypothesis until a diagnosis can be proven to be correct. This is the ideal method.
Medical diagnosing; Pattern recognition:
Compares patters of symptoms with disease prototypes. Effective for easy diagnosis.
Medical diagnosing; Heuristics and biases:
Diagnoses are made based on rules of thumb or heuristics. Least reliable method.
Heuristics
Strategies people use when making decisions or solving problems. Considered short cuts that often lead to biases.
Cognitive error; Premature closure
Narrowing the choice of diagnostic hypothesis too early, thereby missing the correct diagnosis.
Confirmation bias
Inadvertently looking for, noticing, or remembering information with pre-existing expectations, while ignoring information that contradicts expectation.
Availability heuristic
Overestimating the intensity or frequency of vivid or easily recalled events.
Representativeness heuristic
Something that is similar to things in a certain category must be in the category. If it quake like a duck then it must be a duck.
Treatment Framing
If treatment outcome is framed by its gains, people are risk averse. However, if treatment is framed by the benefits of treatment, people are more willing to accept risk.
Decision making; Over-confidence
A major contributor to diagnostic error. Physicians see them as better than average, which leads them to be more likely to trust their heuristics.
Inadequate feedback loops
Physicians use data on patients health outcome as a basis to judge their own capacity. However, many other factors contribute to a patients success. Also, doctors often do not see their patients after diagnosing, and therefore assume they got better.
Illusory correlation
Tendency to believe that two events are causally related, when in fact they may be separate and coincidental.
Rules for good decision making:
Be aware of base rates.
Entertain alternative hypothesis.
Disprove rather than confirm hypothesis.
Remember that you are wrong more often than you think.
Rules for good decision making:
Be aware of base rates.
Entertain alternative hypothesis.
Disprove rather than confirm hypothesis.
Remember that you are wrong more often than you think.
Influences on eating disorders:
Biological
Social
Psychological
Developmental
Social factors in body dissatisfaction:
Media
Family
Socioeconomic class
4 eating disorders
Anorexia nervosa (55%)
Bulimia (8%)
Binge Eating disorder
Avoidant/restrictive food intake disorder
BMI for underweight
> 18.5 underweight
>16.6 severely underweight
Anorexia nervosa
Most common amongst teenage girls, although increasing with males. Restricted eating leads to being underweight, sexually and developmentally delayed. Food obsessed/ritualized. Intense fear of gaining weight and dysmorphic self image.
Apical anorexia nervosa
Same signs as AN, but without being notably underweight.
Anorexia warning signs (some)
Weight loss, calorie counting, body dysmorphia, fatigue/faints, use of diet pills, laxatives, diuretics, low self-esteem, self harm, Jaundice, thin hair, social avoidance.
Anorexia health complications
Amenorrhea (cessation of menstruation), slow heartbeat, low blood pressure, muscle waste, poor circulation, muscle loss, kidney failure (dehydration), chronic constipation, Osteoporosis, depression, disorientation
Bulimia Nervosa
More common than AN but seen less in hospitals. Bulimics have issues with self control and undergo eating binges followed by purging (laxatives, vomiting, fasting, or excessive exercise). Occurs at least once a week for 3 months.
Cases often occur in adulthood, unlike Anorexia.
Bulimia warning signs
Binging, visits to bathroom after meal, weight fluctuations, abuse of pills, teeth stains, sore throat, heartburn, shame, low self-esteem, depression.
Bulimia health complications
Tooth decay, kidney failure, dehydration, electrolyte imbalance, malnutrition, GI problems, ulcers.
Binging Eating disorder
Binge eating without the compensatory behavior of bulimia. However, person feels guilty, ashamed, over stuffed, depressed.
Occurs at least once a week for three months.
Avoidant/restrictive food intake disorder
Food restriction so severe that a person is unable to meet nutritional needs, resulting in health or psychological consequences.
Food restriction is not to do with weight concerns, but rather an overall disinterest in food, high selectivity, or other reasons. Eg, fear of choking, only wanting to eat liquid, only eating a certain brand, etc.
Bigorexia
The male (usually) desire to be big and see themselves as scrawny. Steroids and supplements will often result in complications.
SCOFF questions for eating disorder:
-Sick: do you ever feel Sick from eating to much?
-Control: do you lack Control?
-One: have you lost One stone in there months?
-Fat: do you believe yourself Fat when others disagree?
Food: does Food dominate your life?
A score of 2 or more indicates anorexia or bulimia.
Swiss cheese model
Checks and balances are in place to deter errors, but alas, errors manage to get through the gaps in each stop.
Ten essentials for Safe surgery
- Operate on correct patient and site.
- Prevent anesthetic harm
- Prepare for respiratory loss
- Prepare for blood loss
- Avoid drug allergies
- Prevent retention of surgical tools
- Minimize infection
- Secure and identify surgical specimens
- Team will communicate
- Hospital will practice surveillance
Virtue ethics
Theory of ethics: Aristotelean. Act like a virtuous person. Concerned with development of moral character. Develops later in life.
Aristotle’s golden mean
Virtue lies between deficiency and excess.
Eg. Cowardliness - courage - foolhearted
Divine command theory
Theory of ethics: action guiding principles are derived from God’s command
Deontology
Theory of ethics: Derived from Kant. Actions taken out of sense of duty are truly ethical.
Rights theory
Theory of ethics: derived from John Locke. We all have common, natural rights. Including the right to medicine, self determination, confidentiality.
Utilitarianism/Consequentialism
Theory of ethics: doing the greatest good for the greatest number. In health it requires allocating resources and public policy.
Communitarianism
Theory of ethics: stresses kin, tradition, common purpose.Conventions, loyalties and traditions are the guiding principles of ethics. Defends cultural relativism.
Adolescence in the brain
A second wave of synapse begins in the prefrontal cortex. Reason and risk assessment begin, preparing the youth to take care of themselves.
Erikson’s stages of development
Trust vs mistrust - year 1 Autonomy vs shame - year 2,3 Initiative vs guilt - year 4-6 Industry vs inferiority - 6-12 Identity vs Role confusion - puberty Intimacy vs Isolation - early adulthood Generatively vs self absorption - mid adult Integrity vs despair - late adulthood
Identity vs Confusion
Erik son’s stage of development for adolescents. Teenagers as who am I and where am I going. A time of confusion, experimentation, autonomy and self discovery.
Piagat’s stages of cognitive development
Sensorimotor, birth-2
Pre operational, 2-7
Concrete operational, 7-11
Format operational period, 11-adult
Piagat’s Sensorimotor stage
Develop motor skills and object permanence, birth-2
Piagat’s preoperational stage
Symbolic thought and egocentrism, 2-7
Piagat’s concrete operational stage
Mastery of conservation (understanding that quality may stay the same even as appearance changes). 7-11
Piagat’s formal operational stage
Abstract thought and logical/systematic thinking, 11-adulthood
What are the four parenting styles and which produces the most happy, capable and successful children?
Authoritative. They are demanding but accepting.
How to talk to and treat an adolescent:
Speak with alone and confidentially Be nonjudgemental Normalize their behavior Explore and correct their knowledge Educate about illness Create short term goals Give written instructions Identify barriers Enlist parental support Regular monitoring
What is the leading cause of death for female teens?
Pregnancy. Young mothers are less likely to get prenatal care and twice as likely to die during childbirth.
Risk factors for adolescent mental illness
Family troubles
Stress
Abuse
Bi/homosexual inclination
Marriage and health trends
Fewer people getting married. Median age of marriage going up.
However, married people have live healthier lives and have better health, including immune system psychology and fewer risk factors. Divorced men suffer greater detrimental health effects than divorced women.
Senescense
Deterioration of bodily functions that occurs with age.
Types of elder abuse
Psychological Financial Physical Neglect Sexual
Kubler Ross stages of dying
Denial Anger Bargaining Depression Acceptance
Teratogens
Any agent that can cause birth defects. Tobacco, alcohol, drugs, environmental hazards. Dose, timing, and and genetic susceptibility play a role in the severity of the defect.
Stages of motor development
Milestones about every 2 months. So are stages continuous or discontinuous?
Lifting head, lifting chest, rolling, sitting, support some weight, standing with support, walking.
Erikson stage 1 trust vs mistrust
Develops trust if needs are met, mistrust if not. 0-1 year.
Erikson stage 2 autonomy vs shame
Child wishes to do things on their own. Conflict with parents causes shame. 2-3
Erikson stage 3 initiative vs guilt
Child wishes to build social relationships. Family conflict creates guilt and self-esteem issues. 3-6
Erikson stage 4 industry vs inferiority
Child practices socializing outside of family. Failure to socialize well creates inferiority. 6-12
Erikson stage 5 Identity vs Role confusion
Adolescents search for who they are. Involves a lot of experimentation as they prepare for the world.
Erikson stage 6 Intimacy vs Isolation
People seek loving relationships and social connections. Failure will result in fear of commitment. Early adulthood
Erikson stage 7 Generatively vs self absorption
People attempt to produce something that makes a difference to society. Inactivity and meaninglessness are common fears during this stage.
Erikson stage 8 Integrity vs despair
Later in life people look back at their life and assess their accomplishments. Seek general life fulfillment. Failure to find satisfaction will bring irritability and depression.
Secure attachment
Children are happy to see parents, able to separate from parents, seek comfort when scared. They become social, expressive, confident, and trusting.
Ambivalent attachment
Wary of strangers, unable to separate from parents, not easily comforted upon return. They become weary to for relations, doubtful of love, distraught when a relationship ends.
Avoidant attachment
May avoid parents, does not seek their comfort, shows little preference for parents. They develop intimacy problems, don’t invest in social relationships, unwilling to share thought.
Temperament types
Easy and flexible, Difficult and feisty, slow to warm and cautions, combination.
Post-Partum depression
Lack of interest, pleasure. Disturbances in appetite, sleep, mood, concentration, esteem. Effects 13% of mothers.
Children concepts of illness:
-Incomprehension: 0-2 years
-Phenomenism: 3-5. Dragons make people sick.
-Contagion: 5-7. Magical spread of sickness when nearby people.
Contamination: 8-9. Eating dirt, cold touching you.
Internalization: 9-11. The illness is inside the body but don’t know how or why.
