Patient's Perspective (blue)

Question 1

1. what is patient centred care?
2. What is the sick role?
3. What are the obligations of the patient as part of the sick role? (2)
4. what are the privilages of the patient as part of the sick role? (2)
5. What are the expectations of doctors? (4)
6. What are the rights of doctors? (3)
7. Name the 6 criteria of patient centred care

Answer 1

1. care that is responsive to the wants, needs and preferences of the patient
2. the idea that individuals that have fallen ill are not only physically sick, but they adhere to the specifically patterned social role of being sick
3. they must want to get well as quickly as possible
   they must seek professional medical advice and cooperate with the doctor
4. they are allowed to shed some moral responsibilities and normal activities
   they are regarded as being in need of care
5. apply a high degree of skill and knowledge to the problems of an illness
   act for welfare of patient and community, rather than for own self interest
   be objective and emotionally detatched
   be guided by rules of professional practice
6. examine patients physically and enquire into intimate areas of physical and personal life
   considerable autonomy of professional practice
   occupies position of authority over patient
7. explores patients main reason for visit
   seek integrated understanding of patient’s world
   finds common ground on problem and mutually agrees on management
   enhances prevention and health promotion
   enhances continuing relationship between patient and doctor
   is realistic.

Question 2

1. What is disease?
2. What is illness?
3. How do we elicit the patient’s perspective?
4. Name factors that can influence the whole person?
5. Name factors that it is important for patient and doctor to come to a mutual understanding on

Answer 2

1. a biomedical concept. It is objective and examined by taking a medical history, physical examination and investigations
2. the subjective psychosocial aspect of disease. E.g. feelings and ideas about being ill, impact of illness on function, and expectations of function
3. ICE
4. family, financial situation, education, leisure, social support, media
5. problems and priorities, goals of treatment or management, roles of patient and doctor.

Question 3

1. what is the symptom iceberg?
2. What is illness behaviour?
3. How does illness behaviour differ between the following:
   a) men and women
   b) socioeconimic position
   c) race and ethnic groups

Answer 3

1. used to describe the phenomenon that most symptoms are managed in the community, without people seeking professional care
2. the ways in which symptoms may be differentially perceived, evaluated and acted upon/not acted upon by different people
   3a) women may perceive themselves to be too busy to be ill, however in general, are more likely to seek help for illness
   3b) working classes have functional definitions of health and illness, while middle classes have experimental and expansive definitions
   3c) Black, Asian and Ethnic minorities are more likely to delay health seeking.

Question 4

1. What is medical pleuralism?

2. Describe the lay referral system

Answer 4

1. the use of more than one medical system or the use of both conventional and alternative medicine
2. 1) first recognition of abnormality
   2) announcement to family
   3) announcement to members of the community
   4) announcement to culturally recognised or traditional healers
   5) medical system

Question 5

1. Name 5 triggers to help seeking behaviour (Zola et al)
2. Name 6 factors that can influence health seeking behaviour
3. name 8 factors that may be considered barriers to help seeking

Answer 5

1. interference with work/physical activity
   interference with social relationships
   interpersonal crisis
   putting a time limit on symptoms
   sanctioning/input from friends and family

2. perception and evaluation of symptoms
perceived risk
previous experience
psychological factors - fear of what it might be
denial
concern about using NHS resources

3. provision and availability of resources
   transport
   disruption to work
   attitudes of staff - previous bad experience
   inverse care law - better off areas get better health provision than poorer areas
   geographical distance
   time and effort
   waiting times

Question 6

1. What is an advantage of the use of lay referral and self care?
2. what is a disadvantage of the use of lay referral and self care?

Answer 6

1. reduces pressure and costs on/to the NHS

2. may delay diagnosis and treatment

Question 7

1. What is culture?
2. What is enculturation?
3. What is aculturation?

Answer 7

1. cumulative deposit of knowledge, experience, beliefs, values, attitudes, meanings and material objects acquired by a group of people
2. simple knowledge sharing; process of learning your own group’s culture
3. process of taking on another group’s culture. Involves interaction between 2 cultures

Question 8

1. What is the focus of CAM? (3)

2. Name reasons why people may use CAM (7)

Answer 8

1. focusses on health, wellbeing and wellness.
   Subjective experience of the whole body - holistic view
   emphasis on relationship with practitioner as part of healing process

2. dissatisfaction with conventional health care
poor doctor patient relationship
rejection of conventional sicience
desparation
perceived effectiveness and safety
non invasive
good previous experience

Question 9

1. What is narrative based medicine?
2. How does the Calgary Cambridge Model elicit narrative based medicine?
3. Name 4 consequences of a poor doctor patient relationship

Answer 9

1. the way that illness brings about changes in a person’s social identity, and the way that people respond to the onset of illness
2. it involves understanding the patient’s story in their own words. Also explores ICE
3. inaccurate diagnoses
   less recognition of ICE
   non adherence
   decreased patient satisfaction

Question 10

1. What is medicalisation?

2. What is pharmaceuticalisation?

Answer 10

1. the process of defining an increasing number of lifes problems as medical problems
2. the transformation of human conditions/capabilities into opportunities for pharmaceutical intervention

Question 11

1. what is self care?
2. Why is self care important in terms of wider health care?
3. Name 5 things that people self medicate with

Answer 11

1. individuals taking responsibility for their own health and wellbeing; the actions people take in order to stay fit and healthy, meet social and psychological needs, prevent illness or accidents, and care more effectively for minor ailments and long term conditions
2. Important resource management stratrgy

3. Pharmacy medications
general sale medications
herbal medications
suppliments
illicit substances

Question 12

1. What is the MHRA?
2. What is a POM?
3. What is a P drug?
4. What is a GSL drug?
5. When can a POM change to a P?
6. When can a P change to a GSL?

Answer 12

1. Regulatory body; regulates marketing authorisation of medication and classifies medications as POM, P or GSL
2. prescription only medication
3. can be sold in a pharmacy under the supervision of a pharmacist
4. can be sold in general retail outlets without the supervision of a pharmacist
5. when it is unlikely to cause danger when used without the supervision of a doctor
6. safe to be sold without the supervision of a pharmacist.

Question 13

1. Name 4 community pharmacy schemes
2. What is the tole of the prescriber when taking a history in terms of medications?
3. What are the 3 categories of beliefs about self medications (analgesics)

Answer 13

1. minor ailments scheme
   emergency contraception and sexual health
   medicine use reviews and new medicine scheme
   health education/promotion
2. • find out what OTC/herbal/internet medications a person may be taking
     - prevent re-prescribing ineffective drug/dose
     - prevent drig interractions
     - be aware that OTC/POM medications may be abused
3. reluctant to take mild analgesic
   those who don’t think twice about taking mild analgesics
   those who prefer to let pain run its course.

Question 14

1. what are activities of daily living?
2. name 3 reasons why it is important to appreciate ADL
3. How can ADL affect quality of life? (2)

Answer 14

1. everyday tasks and functional activities that are an essential part of life
2. considered the key to rehabilitation and recovery
   affects quality of life
   important to find out which ADL are affected and how badly
3. maintaining dignity
   psychological issues surrounding not being able to do something - may affect mental health or rehabilitation

Question 15

What are the WHO definitions of the following:

1. Impairment
2. Disability
3. Handicap

Answer 15

1. temporary or permenant loss or abnormality of body structure or function, whether physiological or psychological
2. restriction/inability to perform an activity in the manner or within a range considered normal, mostly as a result of impairment
3. disadvantage for a given individual, resulting from an impairment or disability that limits or prevents fulfilment of a role that is normal for the individual

Question 16

1. What are the major roles of physiotherapists?
2. what are the major roles of occupational therapists?
3. Name some measures that assess activities of daily living

Answer 16

1. assessment of physical impairment
   management of condition
2. functional assessment. occupational issues. quality of life. goal setting
3. measures of disability - Bartel Index, red flag screening
   observation, history taking, self report, clinical examination

Question 17

1. Which ideologies gave rise to the medical model?
2. what is the emphasis of the medical model?
3. name 2 criticisms of the medical model
4. how does the social model describe disability
5. what does the social model but emphasis on?
6. Name 3 criticisms of the social model

Answer 17

1. social darwinism/eugenics
2. emphasises what is wrong/abnormal about the person
3. individualises disability and views it as a personal tragedy
   does not account for social barriers
4. disabled people experience discrimination in the way society is organised. Society fails to make the adjustments that people with impairments need, and this is disabling
5. inaccessable buildings/services
   lack of awareness
   segregation
   poverty and low income
   prejudice and patronising attitudes
6. impossible to remove all barriers (natural barriers; different disabilities may require adjustments that are incompatible with each other; people with the same disability may require different adjustments)
   difficult to apply to all disabilities, in particular learning disabilities/disabilities of social interraction
   ignores impact of impairment (that would still exist even if all barriers were removed)

Question 18

1. What is the radical disability model?
2. How have definitions of disability and impairment been criticised?
3. What are the ICF’s 3 determinants of disability?
4. Name 4 burdens that people with disabilities across the globe face. Why is this?

Answer 18

1. argues that disability is defined as those who are externally identified as disabled or those who self identify as disabled. and that disability is a natural and necessary part of human diversity
2. they take an individualist approach and medialise disability.
3. body and its organs
   human being as a whole
   social environment they live in

4. poorer health outcomes
lower educational achievements
less economic participation
higher rates of poverty
*this is because disabled people have difficulty in accessing services

Question 19

1. What is a carer?
2. Why is the number of carers expected to rise? (4)
3. Why may people not want to identify as a carer?
4. what is the effects of caring on health?
5. Why is this?

Answer 19

1. someone who, without payment, provides help and support to another person who could not manage without their help
2. aging population
   more community/home based care
   lack of services providing care
   increase in long term conditions requiring care
3. might not want to admit that the person they are caring for needs care
   fear of responsibility
   fear of change of relationship dynamic
4. high levels of physical and mental health problems
5. caring has a high level of impact on emotional health
   carers may not have time to look after their own health
   physical exhaustion
   isolation
   battling the system/advocacy

Question 20

1. what are the rights of carers (4)
2. what is carers allowance?
3. name 2 criticisms of the carer’s allowance
4. Name 3 employment related policies for carers

Answer 20

1. right to an assessment of needs, even if the person they care for refuses
   carers special grant - funding for respite
   must be aware of their entitlement to an assessment
   assessments must consider wishes about employment, training, education and leisure
2. benefit for people who regularly spend at least 35 hours a week caring for someone who receives qualifying disability benefit
3. there are a lot of informal carers who regularly spend less than 35 hours a week caring
   it can be difficult for someone being cared for to recieve their entitlements, therefore making it harder for carers to access financial support
4. time off for dependents - employees can request a “reasonable” amount of unpaid time off work
   flexible working regulations - parents of children under 6 or under 18 if they have a disability can request flexible working
   carers of adults can request flexible working.

Question 21

What are the needs of the following specific groups of carers:

a) parents of disabled children
b) rural carers
c) BAME carers
d) young carers
e) employed carers

Answer 21

a) accessing mainstream services
b) information and advice, practical support, transport
c) culturally sensitive services; language issues
d) information and advice, emotional and practical support, transition to adulthood, accessing education
e) juggling work with care; taking time off

Question 22

1. What is health behaviour?
2. what is health impairing behaviour?
3. what is health promoting behaviour?
4. Name 4 reasons why it is important to study/understand health behaviour

Answer 22

1. any activity that people perform to maintain or improve their health, regardless of their perceived health status, or whether the behaviour actually achieves that goal
2. behavioural pathogens such as smoking, high fat diet
3. behavioural immunogens such as exercise, attending screening programmes etc
4. relationship with life expectancy
   behaviours engaged in as a result of disease/disability
   treatment schedules/procedures involve health behaviour
   lifestyle changes involve behaviours

Question 23

1. what is locus of control?
2. what is self efficacy?
3. name 2 ways in which self efficacy can be influenced
4. what is model of illness representation?
5. Describe the 5 illness perceptions relating to illness representation

Answer 23

1. the extent to which people believe they can control their lives
   internal locus of control - controlled by forces within
   external locus of control - controlled by outside forces
2. a person’s belief that they can succeed at a specific activity
3. mastery experiences - previous successes or failures
   observed behaviour - seeing others (particularly role models) succeed
4. proposes that illness perceptions directly influence coping strategies
   illness perceptions are lay interpretations of information and personal experiences that the person has acquired
5. Identity - what is the illness
   timeline
   consequence
   cause
   control - can i self medicate or do I need to seek medical attention?

Question 24

1. what does the health belief model suggest
2. In terms of the health belief model, define the following:
   a) perceived susceptibility
   b) perceived severity
   c) perceived barriers
   d) perceived benefits
   e) cues to action
   f) self efficacy

Answer 24

1. that a person will take a health related action if they feel that a negative health condition can be avoided by taking said action, and that they can successfully perform the recommended action

2a) one’s opinion of chances of getting a health condition
2b) one’s opinion on how serious the condition and its consequences are
2c) one’s opinion of the tangible and psychological costs of the advised action
2d) one’s belief in the efficacy of the advised action to reduce the seriousness of impact
2e) factors prompting action, either internal or external
2f) confidence in one’s ability to take action

Question 25

1. What does the theory of planned behaviour suggest?
2. According to the theory, when are people more likely to adhere to a certain behaviour? (6)
3. What 3 factors influence intentions?

Answer 25

1. that outcomes are driven by a person’s intentions.
2. view their physical problem as severe
   perceive themselves to be succeptible to further negative effects if they fail to adhere
   consider the likelihood of treatment to be effective
   identify few barriers to adherence, and few benefits of not adhering
   encounter environmental cues supporting the decision to adhere
   believe that they can change
3. attitudes, social norms and perceived behavioural control

Question 26

1. Describe the stages of change model

2. identify additional constructs that influence behavioural change (4)

Answer 26

1. precontemplation - no intention to change
   contemplation - weighing up pros and cons of changing
   determinism - determined to make change (in mind)
   active change - putting decision into practice
   maintenance - actively maintaining change
   relapse - return to previous behaviour
2. decisional balance (pros v cons)
   self efficacy
   process of change
   temptation

Question 27

1. Define Medically Unexplained Symptoms
2. Name and describe 2 ways in which illness behaviour can become maladaptive
3. Name 3 reasons for MUS
4. Why is it important to understand MUS? (4)

Answer 27

1. physical symptoms not explained by organic disease, that causes distress and impairs function, and where there is positive evidence/a strong assumption that the symptoms are linked to psychological factors
2. Illness denial - an inability to accept physical/mental illness
   Illness affirmation - behaviours which inappropriately affirm illness. Invalidism or disproportionate disability in relation to symptoms/signs (MUS)
3. reduces stigmatisation of mental illness
   allows people to assume the sick role
   reduces internal emotional conflict
4. persistent MUS can be disabling and distressing
   high health care costs
   high societal costs
   large patient group presenting to GPs/medics/neurologists when they should be seen in psychiatry

Question 28

1. Name 6 aetiological factors of MUS

2. Describe the biopsychosocial model of MUS

Answer 28

1. genetic (small input)
   non-genetic familial transmission - use of physical symptoms as emotional currency within the family
   insecure attachment - links with pathological care seeking behaviours
   over interpretation of symptoms/symptom catastrophising
   early childhood trauma
   central pain mechanism
2. minor pathology/physiological symptoms/side effects of medication at the same time as stress/conflict > interpretation is influenced by childhood experiences, illness beliefs, cognitive process and mental illness > functional symptoms and deficits
   maintaining factors include iatrogenic, mental illness, secondary gains (benefits of being ill) and on going stressors.

Question 29

1. how can MUS be identified in consultation?

2. How can MUS be managed?

Answer 29

1. symptoms don’t fit with disease models
   patient is unable to give a clear and precise description of the symptoms
   symptoms/disability seems excessive compared to pathology
2. acknowledge that the symptoms are genuine
   provide clear explanations about investigations, results and conditions which are excluded
   avoid further investigations and referral
   provide an explanatory model of symptoms
   symptom management
   promote self efficacy
   initiate treatment for depression/anxiety
   psychotherapy

Question 30

1. What are the typical grief reactions?
   a) affective
   b) cognitive
   c) behavioural
   d) psychosomatic
2. what is the universal response to grief?
3. What is the biological basis of grief?
4. What parts of the brain have been implicated in greif

Answer 30

1a) depression, guilt, distress, anhedonia, loneliness, shock
1b) denial, helplessness and hopelessness, memory and concentration difficulties, lowered self esteem
1c) agitation, fatigue, overactivity, social withdrawal
1d) change in appetite, sleep disturbances, somatic complaints

2. crying. Following this, the grief response varies widely between cultures
3. parallels with the distress response seen in children. The yearning and searching behaviour is thought to be a feature that conferred an evolutionary advantage on individuals and kinship groups, as it keeps family units together, thus naturally selecting this behaviour
4. periaqueductal grey - involved in perception of pain. Activated when someone is talking about the emotional pain of loosing someone
   Nucleus accumbens - associated with wanting and yearning

Question 31

1. Describe the stages of grief
2. what is the adaptation or relearning model?
3. What is the meaning making model?
4. what is the balance oscillation model?

Answer 31

1. numbness > yearning and searching > disorganisation and despair > reorganisation
2. choice of adapting to life and relearning the world without the deceased
3. making sense of the loss; if someone can’t do this then they will continue to grieve
4. oscillation between emotional avoidance and confronting loss/grief

Question 32

1. describe a child’s needs following a loss (7)
2. What is complicated grief?
3. What evidence is there surrounding complicated grief?
4. How does grief link to attachment?

Answer 32

1. to know they are going to be cared for
   to know they did not cause the loss
   clear information about death, causes and circumstances
   to feel important and involved
   continued routine activity
   someone to listen to them
   someone to help remember dead person
2. a cluster of symptoms such as anxious and depressive thoughts, painful memories and preoccupation with deceased
3. no conclusive evidence that it exists as a pathological reality, but there is evidence that a range of factors can give rise to complications in normal or common grief
4. emotionally secure individuals tend to recover faster; secure people are also more psychologically resilient.