PPD Flashcards
What is the cultural expertise model
Where training focuses on providing information about different groups based on one characteristic
Why teach about diversity?
Improve pt care Reduce health inequalities Enhances all dr-pt encounters Improve pt safety Develop professionlism
What are the positives and negatives of cultural knowledge?
Pos: May give us information that will help in clinical care.
Neg: Inter vs. intra group heterogeneity.
Static
Doesn’t allow for acculturation
Risks oversimplifications and stereotyping *
Too many categories to learn
What is the first goal of cross cultural education
understand how culture influences our thoughts, perceptions, biases and values
Doctors outcomes for listening and forming relationships?
More rewarding, exciting, few complaints, fewer dissatisfied pts returning
How did DIMAH define culture?
a socially transmitted pattern of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life.
Culture is also a dynamic entity based on heritage, individual circumstances and personal choice.
How did Hofstede define culture?
The collective programming of the mind which distinguishes the members of one group or category of people from another
What makes someone effective in an environment according to Bowlby?
Having a working model of behaviour
Individual with environment skills
What is ethnocentrism?
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.
What is contextual conditioning?
Understanding the nature of culture and how it influences our worldview
What is the Libertarian approach? What is an example?
Each is responsible for their own health, wellbeing and fulfilment of life plan
Eg John Stuart Mill’s Harm Principle
What us article 2?
The right to life
What is article 3?
The right to be free from inhuman and degrading treatment
What is article 8?
The right to respect privacy and family life
What is article 12?
The right to marry and found a family
What us prejudice?
Attitude towards another person based solely on their membership of a group
What is the second goal of Diversity education?
understand the nature of individual cultural identity as a multidimensional and dynamic construct.
What is a stereotype?
Involve generalisations about the ‘typical’ characteristics of members of a group.
What is discrimination?
Actual positive or negative actions towards the objects of prejudice
What is important about assumptions when being self aware?
Knowing when we are making assumptions
Being able to question where these assumptions arise from. ? Experience. ?Stereotypes
Ability to check out assumptions
What is the cultural sensibility model?
We are combination of different characteristics and 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
What are some challenges of working across cultural distances?
Effortful – energising/exhausting Assumptions more likely to be wrong Humour/Rapport Language Different expectations of roles for Dr and patient Different explanatory model
What are the human rights surrounding deprivation of liberty?
Amendment of Mental Capacity Act 2005 to contain the ‘deprivation of liberty safeguards’. - Now called LIBERTY SAFEGAURD POTECTION - providing administrative and judicial safeguards for adults who lack mental capacity who are deprived of their liberty in care homes and hospitals.
What is Hellmans folk model of illness?
Idea and questions that patients want to have answered what is it why has it happened why me why now what would happen if nothing were done what shout I do
What are Kleinmans questions
8 questions devised for non English speakers
What are Hofstede’s cultural dimensions?
A framework for cross-cultural communication.
Describes effects of a society’s culture on the values on its members, and these values relate to behaviour
What are the allocation theories based on?
Egalitarian principles, maximising principles, libertarian principles
What is the egalitarian principle of healthcare?
NHS was founded on requirement to provide all care that is necessary and appropriate to everyone
What is the maximizing principle?
Criteria that maximise public utility
Describe sustainability in resource allocation
The Hippocratic canon (do no harm/do good) transcends to the systems sustaining humanhealth such as global environment.
Brundtland commissions definition: Meets the needs of the present w/o compromising the ability of future generations to meet their own needs
What is the rule of rescue (Jonsen)
The query to whether we can fund expensive treatment to prolong life short term? How does this equate with maximising good with fairness?
What is article 14
the enjoyment of right and freedoms without discrimination of gender/sexuality
What are the absolute right?
right to protection from torture, inhuman and degrading treatment and punishment (article 3)
prohibition on slavery and enforced labour (article 4)
Protection from retrospective criminal (article 7)
what are limited/qualified rights?
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
What are the 3 methods of learning
Transmissive didacticism - lecturing
Cognitivism - slow process of learning, from basic principles
Humanism - personal growth and nurturing
What is the dual process theory?
Using either/both intuitive thinking and analytical thinking:
Recognise a pattern
Analytical or intuitive process?
Make a decision using cognitive short cuts
OR analytical method, decision, check/balances
Outcome
Describe human error: intended actions
mistakes = rule based knowledge lacking
OR violations = routine, reasoned, reckless and malicious
Describe unintended actions human error
Lapses: Memory failure, losing place, omitting items, etc
Or slips - attentional failures, intrusions, omissions, misordering
What is medical negligence?
A legal entity; the outcome of a court case
A civil claim for damages
On the balance of probabilities
You could be found liable, not found guilty
Describe human error in the Wayne Jowett case
Waye due IV vincristine and intrathecal cytosine as chemotherapy for ALL. SHO assumed reg knew how to give chemo. Reg assumed SHO knew lcal policies
What is neglect
Falling below accepted standard
Repeated minor mistakes
Culture of not caring
What is poor performance?
Attitude problem - rudeness, scruffiness, laziness.
Failure to learn from mistakes and listen.
Affects pt care
Evident from student days
What is lack of candour
Hiding own or others’ mistakes
Ignoring mistakes, hoping they will ‘go away’
altering medical records
GMC duties of a dr: report a concern
What is the Bolam test?
Would a group of reasonable drs do the same
What is the Boliho test?
Would it be reasonable for a similar group of drs to do same thing
How can a pt prove they came to harm?
You owed them a duty of care
You breached the duty
They came to harm
Harm was caused by your breach
What is normative decision making?
Describes how popele could/should make decision in philosophical/ethical perspective
What is descriptive decision making?
Looking at how people actually make decisions
Advantages and disadvantages of intuitive decision making?
Ad: Fast/frugal
Dis: Prone to bias
What are heuristics?
Cognitive shortcuts - for availability, representativeness
Describe the biases in intuitive thinking
Error of over attachment
Error due to inheriting thinking
Error due to failure to consider alternative
Errors in prevalence perception or estimation
What is analytical thinking good for?
Measuring and calculating odds - basis of evidence based medicine and research
Advantages and disadvantages of analytical decision making?
Adv: Accurate, reliable
Dis: slow - keeps pts waiting, resource intensive - costs money, cognitively demanding - exhausting
How do we reduce the risks of intuition?
Decision environment and process
Personal and structural debiasing
Describe the decision environment?
Decision density and contingency
Physical environment
Process environment
Describe the affective and cognitive de-biasing techniques
Affective: acknowledgement of bias
Personal accountability
Cognitive: executive override - slowing and stopping, cognitive forcing
Describe structural de-biasing methods
Training
Checklists
Group decisions - MDT, ward round
Describe the human factors involved which could jeopardise patient safety?
Loss of situational awareness
Perception and cognition - stress
Teamwork (no cealr leader)
Culture - assertiveness in team
What is the Asch Solonman project
Showed power of group conformity
What is a never event
Cause harm or even death to patients
Show gaps in provision of quality care
Published n National Quality data
Have financial penalties
What is a transactional leadership style
Leaders promotes compliance by followers through both rewards and punishments
What is transformational leadership?
Leader works with teams to identify needed change, creating a vision to guide the change
