MMI Flashcards
1
Q
Breaking bad news
A
- introduce yourself and your position
- establish their viewpoint, patient’s Ideas, Concerns, Expectations ‘can you tell me a little about what you understand is going on?’
- give a warning shot ‘I have the results of your scan and I’m afraid it is not what we would have hoped for’
- give bad news quickly after in very straightforward terms to avoid confusion
- GIVE THEM TIME, wait for them to say something
- if they don’t say anything then ask ‘What’s on your mind?’
- Offer tissues where appropriate, or if they would like to contact a relative
- ‘would you like to hear about what happens next?’
- CHUNKING-give info in small pieces, CHECKING-keep checking if they understand
- offer to write down information for them if they are not understanding or are likely to forget
- if don’t know answer just say ‘I don’t know myself but I can find out for you or refer you to someone who can answer your questions more fully’
- ASK IF THEY HAVE ANY QUESTIONS
2
Q
Ethical scenario
A
- summarise scenario
- summarise issues to be considered
- ‘there are strong arguments for both sides, so I like to approach these complex scenarios by looking at the 4 pillars of medical ethics’.
- define each pillar and outline whether they are for/against the statement + confidentiality, capacity
- acknowledge that these are dilemmas that you would discuss with colleagues to get other opinions and come to the best decision
3
Q
ethical approaches
A
- consequentialism: if the outcome is +ve, the method/actions don’t matter
- deontology: an action may not be favoured even if it results in a good outcome
- utilitarianism: ‘the greatest happiness for the greatest number’ (e.g. for: vaccination, drugs which may bring good outcomes to the majority but harm to a minority, against: slavery)
4
Q
NHS Constitutional Values
A
WERCIC
- Working together for everyone - all NHS staff have a duty to work well as a team to ensure the wellbeing and proper care of all patients, patient wellbeing must come first over staff disputes and personal feelings etc.
- Respect and dignity - respecting patient’s ideas, needs and values (similar to autonomy)
- Commitment to quality of care - maintaining the highest standard of care possible for all patients
- Compassion - not only recognising that someone is suffering but actively doing everything possible to alleviate this suffering for them
- Improving lives - offering all kinds of support to improve general wellbeing and ensuring +ve healthcare experiences
- Everyone Counts - everyone should receive the same standard of care without exclusion or discrimination
5
Q
how can we reduce A&E waiting times?
A
-public education
-integration of hospital and social care to free up
beds
-expand primary care and community based services as many people come to A&E because they can’t get GP appointments
6
Q
imagine you were in charge of the NHS in city A, there are many students in this city, what are some of the main health issues students face and what would you do about them?
A
- young people engage in more physical activity -> more injuries/traumas -> more demand on A&E
- students may drink alcohol in large volumes or take recreational drugs -> could have accidents/injuries whilst under the influence or addiction problems
- high prevalence of STIs at uni -> promoting safe sex
- mental health -> pressure and workload -> uni support should be available easily and judgement-free
7
Q
What groups in society are most at risk of HIV and how can we protect them?
A
- people who take drugs through the means of needles (e.g. heroin)
- partners of HIV+ individuals
- sex workers
- babies from HIV+ mothers, could reduce risk by avoiding breastfeeding and medication
- providing they are HIV-, they can be given PrEP (pre-exposure prophylaxis) tablets to help prevent infection even if they are likely to share bodily fluids with HIV+ individuals
- ‘treatment as prevention’, HIV+ individuals can have treatment (e.g. antiretrovirals) to reduce their viral load (the level of HIV virus in the blood) until its undetectable. Having an undetectable viral load for 6 months or more means it is not possible to pass the virus on during sex
8
Q
If you were given a large amount of money to conduct research, which field would you do research in?
A
- neurodegenerative diseases (when nerve cells lose function over time and ultimately die), becoming more prevalent especially with an ageing population
- 6 people are diagnosed with MND every day in the UK
- 1 in every 14 of the population aged 65 years and over have Alzheimer’s
9
Q
waiting lists and covid
A
- for elective care, 92% of patients on the waiting list should start their treatment within 18 weeks of being referred to a consultant
- the backlog due to the pandemic has grown rapidly, with 301,000 patients stuck on the waiting list for more than 52 weeks
10
Q
HIV plan
A
- The Government has launched a new HIV action plan, supported with over £23 million of funding, which aims to reduce new infections by 80% by 2025 and end infections and deaths by 2030
- increasing access to pre-exposure prophylaxis (PrEP) for key groups
- PrEP is a drug taken by HIV- people before sexual contact with a HIV+ person
- PrEP is only needed if the HIV+ partner has a detectable viral load (if viral load is undetectable, HIV cannot be transmitted)
- scaling up HIV testing in high-risk populations where uptake is low to ensure new infections are identified rapidly
- ensuring diagnosed people rapidly receive treatment to stop onwards transmission and achieve optimal long-term health outcomes + supporting those with HIV to stay in treatment
11
Q
medical bodies
A
- GMC: a body that maintains the register of medical practitioners within the UK, removing members when necessary, sets the standards for medical schools in the UK
- BMA: a registered trade union for doctors in the UK which represents medical students and doctors and their rights e.g. junior doctor contract
- CQC (care quality commission): regulates health and social care services in England
- NICE: provides evidence-based guidelines for health and care, approving drugs, working out cost benefits of medicines
12
Q
gillick competency
A
- a child under 16 must demonstrate the following to be deemed competent to make informed and independent decisions about their health and treatment:
1. understand the reasons for and nature of the treatment
2. understand the benefits and risks of the treatment
3. understand the consequences of refusal of treatment
4. make a choice free from coercion or pressure
13
Q
fraser guidelines
A
- relates specifically to children and contraception
- advice regarding contraception can be given without telling the parents as long as the child:
- has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
- cannot be persuaded to tell her parents or to allow the doctor to tell them
- is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- physical or mental health is likely to suffer unless he/she received the advice or treatment
- the advice or treatment is in the young person’s best interests
14
Q
mental health
A
- 1 in 4 adults affected, 1 in 10 children affected
- COVID-19 has exacerbated mental health problems: depression/isolation from lockdowns, anxiety because of pandemic, depression from death of a loved one
- NHS staff have been affected by mental health as well: survey
- less stigma, more funding and workforce numbers, more emergency support, education of doctors and nurses to look out for signs of mental health problems
15
Q
NHS Scotland structure
A
- funded by taxation of UK citizens
- NHS budget is decided annually by the government
- the 14 regional NHS Boards are responsible for the protection and the improvement of their population’s health
- prescription items are free in Scotland
- Primary care: first point of contact for patients, e.g. GPs, dentists, pharmacists. As GPs can resolve 90% of patient’s problems, this reduces the pressures on secondary care centres
- Secondary care: hospital based, provides elective (pre-planned care) and emergency care
- Tertiary care: highly specialised treatment reserved for specific complex conditions, has state of the art equipment and facilities
