Med Law Flashcards
What do you consider when making PRActical decisions?
moral Perception
moral Reasoning
moral Action
What’s moral Perception?
ethical?
what are the principles of moral Reasoning?
Beneficence
Non-Maleficence = no harm
Autonomy = Competent patient in control -know what’s best for them–> fulfilling life
Justice = No discrimination/waste resources
what’s moral Action?
implementing ethical practice independently
Features of HCP?
Licensed by the state Belongs to organisation (NHS) Helps needy Exercises autonomy over work XO Has special knowledge
Duties of HCP?
-Duty – What’s expected of you Moral → You Professional → GMC Legal → Law -Utility – Skills -Rights – Respect autonomy -Virtue – Want best outcome
Types of laws?
common, quasi, statute
What’s common law?
developed by judges + courts, decide each case, but have a precedential effect on future cases
What’s quasi law?
rules set by GMC- regulatory body
What’s statute law?
decided by government via legal frameworks eg MHA 2005
Define consent
voluntary, un-coerced decision made by competent or autonomous person on basis of adequate info + deliberation, to accept rather than reject some proposed course of action (Gillon 1986)
Types of consent?
Imputed: assumed
Implied: actions suggest
Expressed: written + oral
what are the parts of valid consent?
- Informed about procedure
- Competent: patient understands, use/weigh up, retain info, communicate decison
- Not forced- voluntary
define competence
patient understands, use/weigh up, retain info, communicate decision
define gillick competence
child under 16 able to consent to treatment w/o parents permission/knowledge?
how is gillick competence accessed?
Each case diff
- willingness
- understanding of the nature +purpose
- understanding risks + side effects
- understanding of alternatives + risks
- freedom from undue pressure.
define child
below 18
what if child refuses treatment?
Parents can overrule the child’s refusal
what’s parental consent limited by?
best interest so may not be able to consent to
certain treatments OR refuse life saving treatment w/o court approval
who has parental responsibility?
Birth Mother Biological father if married to mother when conceived Step parents Local Authority (if care order made) Adoption agency Legal guardian
if biological father unmarried to mother when conceived?
father has to get written agreement from mother + court order to be registered as father on birth certificate + legal parental guardian after mothers death
what if parent refuses certain treatment?
can be overruled by the courts if in the best interests
what if only 1 parent gives consent?
HCP can accept conse nt + perform treatment
what if parent’s disagree on best interests?
courts can make decision
what if emergency + waiting for parental consent?
treatment can proceed w/o consent
Types of disabilities?
Impairment (Biological)
Disability (Psychological)
Handicap (Social)
define impairment
Physiological/anatomical dysfunction
define disability
Can’t do certain things other people can do due to impairment
define handicap
Given by society to disabled person that stops them from doing things they’re capable of
Prescribing drugs for non-patients:
Prescribing Controlled Drugs for someone w/o professional relationship is professional misconduct - GMC
Unwise to prescribe for themselves, friends,family - Shipman Inquiry
GMC, RCGP, BMA regard self-prescribing as poor practice
what do you do if self prescribing or family?
make a clear record tell GP(treating doctors) what medicines prescribed
when’s parental consent not needed?
Emergencies
Abandonment
Abuse
types of mental illness?
psychosis
neurosis
define psychosis
Can’t distinguish between reality+fantasy
Impaired insight = don’t know they’re delusional
define neurosis
No distortion of reality but still distressed
Insight unaffected
how mental illnesses classed?
organic
functional
define organic mental disorder
physiological explanation, affecting the brain
define functional mental disorder
no physiological explanation-psychiatric illness
define felt stigma
feel people discriminate against you due to your illness
define enacted stigma
actually discriminated against due to your illness
define intelligence + intelligence quotient
Ability to understand, use, apply info
Higher IQ = better intelligence
average = 100
how’s intelligence determined?
Childhood nutrition
Environmental toxins (lead)
Drugs in utero (alcohol)
Intellectually stimulating environment in childhood
Neurological injury/disease
Genetic disorders affecting brain development.
male vs female intelligence?
Men -visuo-spatial (extreme ends)
Females -arithmetic + verbal reasoning (consistent)
define classic conditioning
neutral stimulus –> conditioned response to unconditioned stimulus
define operant conditioning
learning from punishment/reward
how memorizing happens?
Memorising = sensory information stored sensory store – short term memory –>stored in long term memory
Components of short term memory?
Phonological loops – info in speech
Visuo-spatial sketchpad – info in visual
Central executive – paying attention
Factors affecting retrieval?
Context – place learnt
Elaboration/repeating
Organisation
Retro/pro-active interference
diff between Retro-active vs Pro-active?
- new info impedes recall of previous
- while writing a list you forget the former items as you write the latter items
diff between recognition vs recall?
- recognising stimulus
- reconstructing original stimulus from cue + long term memory
why memory vital w patients consultation?
beginning + end
concrete examples (¼ of a pill vs 200mg)
Short, simple sentences
Important, amount , organized, repeated info
define Bereavement
state of having lost someone/ something which emotionally attached to
define Grief
painful emotions associated w loss: 😢, 😡, guilt, shame, anxiety
define Mourning
psychological processes triggered by loss + process of recovery-visible grief
what are the stages of Grief?
(DABDA) •Denial •Anger •Bargaining •Despair (depression) •Acceptance
define unsolved mouring
grief don’t change 6 months after loss
define delayed/absent grief
NO symptoms after loss manifests later –>
why do Bereaved individuals have higher mortality?
- increased cortisol + decreased level of NK cells
- neglects new symptoms
- no self care
- Alcohol/substance abuse
- Change in health practice (eg forgetting to take tablets)
Models of Psychology and Health Behavior?
Health Belief Model Theory of Planned Behavior Cognitive Dissonance Theory Trans-theoretical Model PRIME theory
Define Health Belief Model
Perceived threats cause changes in health behavior but are influenced by other factors
Describe Health Belief Model
liver THREAT!!!!!!!!!!!
Likelihood to ❌🥤depends:
•cues to action eg raised liver count
•perceived susceptibility+severity of disease
•modifying factors- age, socioeconomic status
•perceived benefits (lessens risk) + perceived barriers to action (but the withdrawl..)
pros of health belief model?
Identifies physical barriers (cost/travel/withdrawal)
Compares diff factors - cue > cost
cons of health belief model?
excludes:
- irrationality in health behaviour
- emotion/habits/social factors
- reason for health changes (losing weight to look good or for health?)
- threat -/-> change - 🚬
describe theory of planned behaviour
- attitude towards 🚬- only a lil puff
- social influences -beliefs about others opinions- nitty
- perceived control: how much control you have- i can stop
- ——>INTENTION –> change
pros of theory of planned behaviour
Identifies perceived control + social norms
cons of theory of planned behaviour
excludes: intention --/--> change addiction future/ re-bounds (anticipatory regret) Diff morals determine diff behaviours
define cognitive dissonance theory
‘Guilty feeling’ when 2 cognitions conflict
Cognition 1: I do better in exams when 🚬
Cognition 2: increases lung cancer risk
how cognitive dissonance resolved?
- Change ❌🚬
- Adding 3rd cognition (nitty, so pointless / I’ll stop in the new year)
- Removing 1 or both cognitions (odds of lung cancer low)
- Changing 1 or both cognitions (exams>lung cancer)
- Avoiding thinking about cognitions
pros of cognitive dissonance?
Guilty is easy just add a cognition
cons of cognitive dissonance?
No social/emotional factors
Purely individual
define Transtheoretical Model
Changing health behaviour has distinct, timely steps
steps of transtheoretical model?
Pre-contemplation: no intention in next 6 months
Contemplation: intending in next 6 months
Preparation: intending within next month
Action: change within 6 months
Maintaining change: preventing relapse (6 months to 5 years)
pros of transtheoretical model
Easy to implement
Identifies steps where can fail
cons of transtheoretical model
dont go via all the steps at the same time
Contemplation –/–> action
Change is spontaneous
excludes barriers
define PRIME theory
Change if desire to change> 🚬
Impulse > inertia
diff Models of Stress?
The General Adaptation Syndrome
Life change model
Transactional Model
define The General Adaptation Syndrome
Focuses RESPONSE to stress
describe The General Adaptation Syndrome
ALARM–> fight or flight
Body adapts to the stressor
Fails resistance so exhausted emotionally + physically –> breakdown
cons of The General Adaptation Syndrome
diff people respond diff to stressors
Diff stressors of diff magnitude (eg exam vs death of cat)
define Life change model
Focuses STIMULUS of stress
describe Life change model
Stress = life changing events over time
Accumulation of events are effect health
Based on a checklist of life events which all have diff values (divorce>exam)
cons of life change model?
diff people respond diff to stress
Not all the events bad - yay divorce
define Transactional Model
Focuses on stress as DYNAMIC INTERACTION
describe Transactional Model
Demands don’t meet resources
Perceived demand of stressor can be balanced by coping
Good coping skills = less stress (meditation)
so stress= demand>cope
cons of Transactional Model
excludes:
- sudden stressors eg car crash
- wider social + individual differences
define CBT
helps to SEE thoughts that accompany negative emotions/behaviour- keep diary
steps of CBT?
IDENTIFIES thought
REMOVES thought
EDUCATED to stay away from thought
Models of Mental Illnesses?
Biological disease model Social Model Psycho-dynamic Model Behavioral Model Cognitive Model
define Biological disease model
Mental illness =biochemical change 🧠
define social Model
Social influences awakens mental illnesses + vital in preventing its appearance
define Psycho-dynamic Model
Mental life is unconscious but influences our conscious thoughts + behaviour. so symptoms show unconscious processes
define Behavioral Model
good + bad behaviors learnt so CBT change s dysfunctional behavior
define Cognitive Model
displays biased/incorrect/ hard-wired thoughts which appear during episodes of mental illness
Psychological illness stems from thoughts
THINK differently
where consent not needed?
- Necessity: treatment best option incompetent patient
- Emergency: act to prevent harm
- Children and when patients pose risk to others
define help seeking model
‘accomodation’ breaks down –> seek help
consult w internet first then make self diagnosis
define lay health beliefs
Ideas that are held by the public
describe lay health beliefs
I Make Bad Decisions
INVASION – 🐛
MECHANICAL – injury to cartridge can cause arthritis
BALANCE – healthy diet and exercise prevent diabetes
DEGENERATION - old body breaks down->osteoporosis
eg of lay health beliefs
Health as functional capacity - healthy? work
Body as physical capital - like machine
Emotional wellbeing - optimism manages illness
Disease candidacy - genes
Reflection of lifestyle - nitty
Duality of health - odds w society
define crisis model
Diagnosis of chronic–> LOSS OF SOCIAL STATUS–> BIOGRAPHICAL DISRUPTION
Loss of social status – primary deviance
Behaviour change – secondary deviance
describe crisis model
Enacted stigma Felt stigma Impairment or disability Negative labelling Diminished self esteem and withdrawal It can however lead to NEGOTIATION - refusing to accept stigmatisation,adjustments, maintaining identity
adaption to chronic?
- Adjustment to : symptoms, incapacities + treatment procedures
- Developing + maintaining relationships w : HCP, family, friends
- Preserving : emotional balance, good self image + competence
- Preparing for uncertain future
what are the social aspects of nutrition?
biology – genes
activity – lifestyle
psychology – food for compensation
Food consumption – less family meals
Food preparation – meal deals, fast food
Activity environment – city vs farm life
Cultural/social factors – health vs cost
define risky health behaviour?
Epidemiological studies to identify at risk groups eg 🚬 lung cancer
cons of risky health behaviour?
PICS Assumes risk is PERSONAL CHOICE Ignores IMMEASURABLE FACTORS Assumes risk is CONTROLLABLE Correlation but SILLY ASSOCIATIONS
Types of studies?
Observational
Interventional
what’s observational study?
Cross sectional
Cohort
Case control
what’s interventional study?
Randomised control trial Blinding (single vs double) Randomisation Control group Intention to treat vs treatment on analysis
define epidemiology
branch of med - deals w incidence, distribution, control of diseases, other factors relating to health.
define Prevalence :
number of people w disease in point/period of time
define Incidence:
number of new cases in period
define Population perspective:
wider social, demographic , economical and technological causes –>spread of disease
define Standard error:
measures spread of MEANs = precision of sample
define Reference range:
mean ± 2SD = 95% of values lie here
what’s 95% Confidence interval
mean ± 2SE
define P value
shows the likelihood of results being due to chance
describe statistical sig
p<0.05
when sig REJECT null
CI ratio = cannot cross 1
CI absolute values = cannot cross 0
