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3a > Other:Ethics > Flashcards

Other:Ethics Flashcards

1
Q

What are underlying assumptions in rights?

A
  • The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status
  • These claims can be made against a duty bearer such as the state and are universal.
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2
Q

What rights are frequently engaged in healthcare?

A

• Art 2 – the right to life (limited)
• Art 3 – the right to be free from inhuman and degrading treatment (absolute)
• Art 8 – the right to respect for privacy and family life. (qualified)
• Article 12 – right to marry and found a family
(limited and qualified rights can be restricted if other circumstances occur)

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3
Q

What are absolute rights?

A
  • right to protection from torture, inhuman and degrading treatment and punishment (Article 3),
  • the prohibition on slavery and enforced labour (Article 4)
  • protection from retrospective criminal penalties (Article 7)
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4
Q

What are limited/qualified rights?

A
  • These rights are limited under explicit and finite circumstances,
  • e.g., right to liberty (Article 5)
  • Article 8(2) - state can restrict the right to respect for private and family life;
  • To protect health or morals, or the protection of the rights and freedoms of others; social needs
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5
Q

What is the libertarian approach?

A

each is responsible for their own health, well-being and fulfilment of life plan.
eg. vaccinations compulsory? Blood donation?

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6
Q

Is there a right to medical treatment?

A

Article 2: there is a positive obligation upon the State; to take appropriate steps to safeguard life. But cannot impose an impossible or disproportionate burden on the authorities.

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7
Q

What is a judicial review?

A

opportunity for an individual to challenge the exercise of power by a public body.

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8
Q

What are exceptionality criteria?

A

It is proper for an authority to adopt a general policy for the exercise of such an administrative discretion, to allow for exceptions from it in ‘exceptional circumstances’ and to leave those circumstances undefined’

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9
Q

What is sustainability?

A

: meeting the needs of today without compromising being able to meet the needs to tomorrow.

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10
Q

What is Peyton’s 4-step procedure for skills training?

A

1) Trainer demonstrates without commentary
2) Trainer demonstrates with commentary
3) Learner talks through and trainer does
4) Learner talks through and learner does

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11
Q

What are the common pitfalls of Peyton’s 4-step procedure?

A
  • Lack of clarity, thoroughness and accuracy of description – what to look at and for
  • Accuracy and consistency of the demonstration
  • Failing to make use of all senses
  • Talking too much
  • Insufficient time for the student to get the feel of a feature or practice the skill
  • Failing to provide opportunities for repeated practice
  • Failing to check student/trainee understanding of what they are doing and why
  • Giving insufficient feedback
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12
Q

What are Pendleton’s rules for feedback?

A

1) Clarify any points of information/fact
2) Ask the learner what they did well
3) Discuss what went well, adding to your own observations
4) Ask the learner to say what went less well and what they would do differently next time
5) Discuss what went less well, adding your own observations and recommendations

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13
Q

What is questioning useful for?

A
  • Learning needs analysis
  • Raising awareness
  • Developing clinical reasoning
  • Formative assessment purposes
  • Clinical debriefing
  • Teaching
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14
Q

List some questioning strategies

A 
Evidence  
Clarification 
Explanation  
Linking and extending  
Hypothetical 
Cause and Effect 
Summary and Synthesis
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15
Q

Why do you need to teach diversity education?

A

o Reduce health inequities
o Enhances all doctor-patient encounter
o Improves patient safety
o Develops professionalism

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16
Q

What is the cultural-expertise model?

A

where training focuses on providing information about different groups based on one characteristic

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17
Q

what are positives of culture-expertise model?

A

may give us information that will help in clinical care

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18
Q

What are negatives of culture-expertise model?

A
  • Inter vs intra group heterogeneity
  • Static
  • Doesn’t allow for acculturation
  • Risks oversimplification and stereotyping
  • Too many categories to learn
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19
Q

Define epigenetic

A

the study of changes in organism caused by modification of gene expression rather than alteration of the genetic code itself?

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20
Q

What is culture?

A

socially transmitted patter on shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life.

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21
Q

Describe the iceberg model of culture

A

Visible: gender, age, ethnicity, nationality
Below surface: socio-economic status, occupation, health, religion, education, social groupings, sexual orientation, political orientation, cultural beliefs.

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22
Q

Describe kahneman thinking

A

Thinking, fast and slow
System 1: fast, unconscious, automatic, everyday decisions, error-prone
System 2: slow, conscious, effortful, complex decisions, reliable

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23
Q

Define ethnocentrism

A

the tendency to evaluate other groups according to the values and standards of one’s own cultural group, especially with the conviction that one’s own cultural group is superior to the other groups.
e.g. colonialism, Nazi Germany, big fat Greek wedding

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24
Q

Define stereotype

A

Involves generalisations about the ‘typical’ characteristics of members of a group.

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25
Q

What are the goals of cross-cultural education?

A

1) The first goal of cross-cultural education is to understand how culture influences our thoughts, perceptions, biases and values.
2) The second goal is to understand the nature of the individual cultural identity as a multidimensional and dynamic construct.

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26
Q

What is prejudice?

A

Attitude towards another person based solely on their membership of a group.
o Cognitive: involves stereotypes
o Affective: involves negative or positive feelings towards someone

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27
Q

what is discrimination?

A

actual positive or negative actions towards the objects of prejudice

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28
Q

What is the cultural sensibility model?

A

We are a combination of different characteristics and that there is a complex interplay between internal and external factors to produce unique beings with their own sense of self, and having a very personal culture

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29
Q

What are some challenges of working across cultural distance?

A 
	Effortful – energising/exhausting
	Assumptions more likely to be wrong
	Humour/Rapport
	Language
	Different expectations of roles for Dr and patient
	Different explanatory model
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30
Q

What are the different forms of empathy?

A

o Cognitive empathy: perspective taking
o Emotional empathy: physical experience of sharing someone’s emotions
o Compassionate empathy: the drive to do something practical for people in difficulties
o Perspective taking: really important attribute for doctors, but cognitive empathy alone can be problematic (sociopaths, narcissists)
o Emotional empathy excess can lead to burnout.

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31
Q

What are kleinman’s 8 questions?

A

1) What do you call the problem?
2) What do you think has caused the problem?
3) Why do you think it started when it did?
4) What do you think the sickness does? How does it work?
5) How severe is the sickness? Will it have a long or a short course?
6) What kind of treatment do you think the patient should receive?
7) What are the chief problems the sickness has caused?
8) What do you fear the most about the sickness?

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32
Q

What are the 2 questions in helmen’s folk model of illness?

A

 What has happened?

 Why has it happened?

33
Q

What is quality improvement?

A

The combination of a change with a method to attain a superior outcome.

34
Q

What are the 5 P’s for assessment in quality improvement?

A

1) purpose
2) patients
3) professionals
4) processes
5) patterns

35
Q

What is the structure of quality improvement?

A

1) investigate problem and make assessment (5Ps)
2) generate a diagnosis (change ideas)
3) apply and iterate treatments (plan, do, study, act cycle)
4) monitor and follow up (sustain)

36
Q

What does PDSA stand for?

A

plan
do
study
act

37
Q

What is the great man theory?

A

Suggests that leaders are born, not made, shaping history through their personal attributes, such as charisma, intelligence and wisdom.

38
Q

What is the trait theory?

A

It states that people possess certain traits that cannot be learnt, certain traits are particularly suited to leadership, and those who possess these traits can lead in very different situations.

39
Q

What is the behavioural theory?

A

This differs by focussing on what leaders actually do. Successful leadership behaviours can be differentiated from ineffective behaviours. Blake and Mouton’s Leadership Grid is a well-known model of behavioural theory,

40
Q

What is the contingency theory?

A

This focuses on how leaders operate depending on the situation. Different contexts require different leadership styles. Effective leaders develop different ways of working with their followers depending on the situation and the needs and attributes of followers.

41
Q

What is transactional leadership?

A

This occurs where the leader, possessing clear authority, motivates by reward or punishment. Transactional leadership is still practised widely in healthcare settings.

42
Q

What is transformational leadership?

A

This states that people will follow a leader who inspires them through vision, passion and enthusiasm. In this respect transformational leaders can truly be seen as change agents, placing the concern and development of others above themselves.

43
Q

What factors cause human error?

A

communication, judgement error, omissions, lapses, violations

44
Q

What is neglect?

A 
	Falling below accepted standard
	Repeated minor mistakes
	Culture of not caring
	Necessary care is withheld
	Safeguarding
	Nutrition and personal care
	Medical care
45
Q

What is poor performance?

A

 A problem of attitude
 Often rudeness, tardiness, scruffiness and laziness
 Failure to learn from mistakes and listen to advice
 Affects patient care
 Usually evident from student days

46
Q

What is misconduct?

A 
	Deliberate harm
	Lack of candour
>Hiding own or other’s mistakes
>Ignoring mistakes, hoping they’ll go away
>Altering medical records
>Failing to report concerns
	Fraud/theft
>False expense claims
>Time: sickness
>Drug + alcohol problems		
	Improper relationships 
>Patients
>Relatives
>Colleagues – students/juniors with supervisors
47
Q

What are the 4 tests to demonstrate medical negligence?

A

1) Was there a duty of care?
2) Was there a breach in the duty of care?
3) Did the patient come to harm?
4) Did the breach cause the harm?

48
Q

What is the Bolam test?

A

Would a group of reasonable doctors do the same?

49
Q

What is the bolitho test?

A

Would it be reasonable for a doctor to do so?

50
Q

What are Aristotle’s virtues?

A
  • Moral virtues: courage + integrity

- Intellectual virtues: knowledge, skill and judgement

51
Q

What is expected utility theory?

A

EU = likelihood x value

Works for risks and gains

52
Q

What are the limitations of expected utility theory?

A

Poor at estimating likelihood and values

53
Q

What is dual process theory?

A

1) Intuitive thinking with its irresistible combination of heuristics and biases
2) Analytic thinking, using evidence-based medicine
Not always ‘either/or’  often both

54
Q

Describe intuitive decision?

A

Recognition primed and heuristic, irresistible, without conscious reasoning

55
Q

Advantages and disadvantages of intuitive decision?

A

Advantages: fast + frugal (using heuristics)

Disadvantages: strong (cognitively predisposed to recognise; prone to biases)

56
Q

What are biases in intuitive thinking?

A

i. Error of over-attachment: confirmation bias, premature closure, sunk costs
ii. Error due to failure to consider alternative: multiple alternatives bias, search satisfaction
iii. Error due to inheriting thinking: diagnosis momentum, framing effect
iv. Errors in prevalence perception or estimation: availability bias, base-rate neglect, gamblers fallacy

57
Q

What is an advantage of analytical thinking?

A

Accurate and reliable

58
Q

Disadvantages of analytical thinking?

A 
Slow - keeps other patients waiting)
Resource intensive (costs money)
Cognitively demanding (exhausting)
59
Q

What 3 ways can you reduce the risks of intuition?

A

1) decision environment + process
o Decision density + contingency (distractions)
o Physical environment (noise)
o Process environment

2) personal debasing techniques
o	Affective
>Acknowledgment of bias
>Personal accountability – anxiety, hunger, fatigue
o	Cognitive: executive override
>Slowing + stopping techniques
>Cognitive forcing strategies
3) Structural debiasing
o	Training in DPT
o	Structural forcing strategies
o	Checklists
o	Group decision strategies: MDTs, ward rounds
60
Q

What are never events?

A

Events that cause harm or even death to patients

61
Q

What are some examples of never events?

A

o Surgery e.g. wrong site or implant, retained foreign object
o Medicine e.g. wrong preparation, wrong route, overdose etc
o Mental health e.g. suicide
o General healthcare e.g. falls from windows, entrapment in bed rails, misplaced NGT, misidentification
o Maternity e.g. death due to PPH

62
Q

What are some red flags of error chains?

A
  • Ambiguities/anomalies/conflicting information/surprises.
  • Broken communication or inconclusive discussions
  • Confusion/loss of awareness/uncertainties
  • Missing information/incomplete briefing
  • Departures from standard procedures/normal practices
  • Fixation/pre occupation
  • Time distortion/event runaway
  • Unease/fear; Denial/stress/action
  • Alarm bells in your mind or warning from equipment
63
Q

Describe the Swiss-Cheese model

A
  • based on an understanding that every step in a process, or every layer of a system, has weakness that can lead to failure
  • likened processes or systems to slices of swiss cheese laid side by side. The holes represent potential weakness at each particular stage or layer
  • some of the holes are considered ‘active’ – an individual making an error, and others are ‘latent’ – these weaknesses are inherent to the system and may include poor organisational design or weak management systems.
64
Q

Describe the three-bucket model

A
  • Based on the understanding that frontline staff can help to stop errors and unsafe practice occurring they adopt a risk-aware and ‘error-wise’ mindset. This will enable them to recognise situations with a high risk of error occurring and improve their ability to correct errors early.
  • The ‘buckets’ in the model represent ‘self’, ‘context’ and ‘task.’ The model’s contention is that the possibility of error or unsafe action in any given situation depends to a large extent on how much ‘bad stuff’ is in those 3 buckets at any particular time.
  • The 3 buckets are constantly emptying and filing at any point in time in response to whatever is happening at that time: an empty bucket in the morning does not necessarily mean an empty bucket in the afternoon. The key is having an awareness of the state of the buckets and developing strategies to empty them when they look full.
65
Q

what are the 3 domains in the 3 bucket model?

A

1) self
2) context
3) task

66
Q

how can culture lead to never events?

A

• Top-heavy structure (e.g. power/control)
• Lack of clear identity
• No clarity on who was responsible
• Lack of inter-professional collaboration
e.g. Bristol heart scandal, north Staffordshire, baby P

67
Q

what is the conformity problem?

A

The greater the benefits and lower the likely consequences, the more common it is for people to ‘migrate’ towards working in ways that they know to be wrong or that break the rules. Over time these ways become normalised and are integrated into the culture.
e.g. “this is how we do it here”

68
Q

What are some examples of reasons why patient safety might become compromised?

A

1) loss of situational awareness
2) perception + cognition
3) teamwork
4) culture

69
Q

Define error type: Sloth

A

Not bothering to check
results/information for accuracy.
Incomplete evaluation.
Inadequate documentation.

Poor conscientousness.

70
Q

Define error: Fixation and loss of perspective

A

Early unshakeable focus on a
diagnosis. Inability to see the
bigger picture. Overlooking
warning signs.

Poor situational awareness and poor open mindedness

71
Q

Define error:Communication

breakdown

A

Unclear instructions or plans. Not
listening to or considering others
opinions.

Ineffective communication

72
Q

Define error: Poor teamworking

A

Team members working
independently. Poor direction.
Some individuals out of depth,
others underutilised.

73
Q

Define error: Playing the odds

A

Choosing the common and

dismissing the rare event.

74
Q

Define error: Bravado

A 
Working beyond your competence
or without adequate supervision. A
show of confidence to hide
underlying deficiencies (not taking
on that which you should)
75
Q

Define error: Ignorance

A

Lack of knowledge. Unconscious incompetence. Not knowing what you don’t know.

Poor self-awareess

76
Q

Define error: Mis-triage

A

Over/underestimating the
seriousness of a situation.

Poor prioritisation

77
Q

Define error: Lack of skill

A

Lack of approrpriate skills, teaching

or practice.

78
Q

Define error: System error

A

Environmental, technology,
equipment or organisational
features. Inadequate built in
safeguards.

3a (25 decks)

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