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3a GP and public health > PPD > Flashcards

PPD Flashcards

1
Q

what is diversity education?

A

understanding ourselves!

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2
Q

What is the goal of cross cultural education?

A

understand how culture influences our thoughts, perceptions, biases and values

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3
Q

Why is diversity education important?

A
  1. reduce health inequalities
  2. enhance all doctor patient encounters
  3. improves patient safety
  4. develop professionalism
  5. better health outcomes for patients
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4
Q

What are the challenges that diversity present in healthcare?

A
  1. effortful
  2. assumptions more likely to be wrong
  3. humour/rapport
  4. language
  5. different expectations for roles for doctor and patient
  6. different explanatory models
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5
Q

Name 2 explanatory models of illness

A
  1. hellmans folk model

2. Kleinmans model

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6
Q

Describe hellmans folk explanatory model of illness

A 
what has happened? 
why has it happened?
why has it happened to me?
why now?
what would happen if nothing were done?
what should i do?
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7
Q

Describe kleinmans explanatory model of illness

A
  1. what do you think has caused the problem?
  2. why do you think it started when it did?
  3. what do you think the sickness does?
  4. how severe is the sickness?
  5. what kind of treatment do you think i should receive
  6. what are the chief problems this sickness causes
  7. what do you fear most about this sickness
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8
Q

Define culture

A

socially transmitted patterns of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life

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9
Q

Define individual culture

A

an individuals identity may be based on their heritage as well as individual circumstances and personal choice - DYNAMIC ENTITY

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10
Q

Define ethnocentrism

A

the tendency to evaluate other groups according to the values and standards of ones own cultural groups, especially with the conviction that ones own cultural group is superior to the other group

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11
Q

Define medical ethnocentrism

A

the belief that health care providers, educated and socialised within a bio-medical contact, have a superior value system and correct, accurate approach to health care

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12
Q

What are the negative consequences of medical ethnocentrism?

A
  1. patient refusal to communicate his/her beliefs and behaviours for fear of negative reaction
  2. significant info for patient care not obtained
  3. health care provider may use his/her own beliefs only and be totally incorrect
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13
Q

Define stereotype

A

involve generalisations about the typical characteristics of members of a group

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14
Q

Define prejudice

A

attitude towards another person based solely on their membership of a group

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15
Q

Define discrimination

A

actual positive or negative actions towards the object of prejudice

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16
Q

Explain Hofstedes cultural dimensions theory

A

a framework for cross-cultural communication

describes the effects of a society culture on the values of its members and how these values relate to behaviour

uses a structure derived from facto analysis

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17
Q

Define epigenetics

A

how our genetic predisposition can be altered depending on our life experiences

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18
Q

Define “discipline of patient safety”

A

the coordinated efforts to prevent harm, caused by the process of healthcare itself,

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19
Q

List the human factors that can risk patients safety

A 
loss of situational awareness
perception and cognition
team work - no clear leader
culture - hierarchy of the team
lack of resources
distraction
pressure/stress
fatigue 
lack of knowledge 
lack of communication
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20
Q

List the red flags of evolving error chains

A 
conflicting information
broken communication 
confusion/ uncertainties 
missing information/ incomplete debrief 
not following standard procedures
unease/fear/ denial
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21
Q

What is the conformity problem?

A

it is more common for people to move towards working in ways that they know to be wrong or that break the rules if greater the benefits and lower the likely consequences

over time these ways become normalised and integrated into culture

“this is how we do it here”

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22
Q

List the 3 leadership styles

A
  1. Transactional
  2. transformational
  3. delegative “laissex faire”
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23
Q

Describe transactional leadership

A

the leader taps into his followers higher needs and values, inspires them with new possibilities and raise their confidence

“ill do something for you, if you do something for me”

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24
Q

Describe transformational leadership

A

proactive, takes responsibility for oneself, for patients and for colleagues
provides support and recognition of others
raises moral and motivation

= F1 LEVEL LEADERSHIP!

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25
Q

describe delegative leadership

A

leaders are hands off and allow the group members to make the decisions

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26
Q

Define rationing

A

resource refused because of lack of affordability rather than clinical ineffectiveness

27
Q

Why have rationing needs increased?

A

shift from acute illness to chronic long term

normal physiological events medicalised

increase in choice and increase in expensive drugs

28
Q

What are the allocation theories based on?

A
  1. egalitarian principles
    = NHS was founded on a requirement to provide all care that is necessary and appropriate to everyone
  2. maximising principes
    = criteria that maximises public utility
  3. libertarian principles
    = each is responsible for their own health, well being and fulfilment of life plan
29
Q

Define human rights act

A

forms part of the decision making process when making decisions about peoples rights

30
Q

What are the problems with human rights?

A

are they universal?
which interests are significant enough to justify ennobling a human right?
all basic rights are claim rights?
can absolute claims conflict?

31
Q

Define health

A

the state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity

32
Q

List some rights that are frequently engaged in healthcare and relevant to clinical practice

A

ACT 2 = the right to life

ACT 3= the right to be free from inhuman and degrading treatment

ACT 8= the right to respect for privacy and family life

ACT 12= the right to marry and found a family

33
Q

List the absolute rights

A
  1. right to protection from torture, inhuman and degrading treatment and punishment
  2. the prohibition on slavery and enforced labour
  3. protection from retrospective criminal penalties
34
Q

Define judicial review

A

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

35
Q

List the 3 concepts of teaching and learning

A
  1. transmissive didacticism
  2. cognitivitism
  3. humanism
36
Q

Describe Kobs learning cycle

A
  1. experience = activist
  2. review, reflect on experience = reflector
  3. conclusions drawn= theortist
  4. what can I do differently next time= pragmatist
37
Q

Describe the tripartite model

A
  1. SURFACE
    = fear of failure, desire to complete course
  2. STRATEGIC
    = desire to be successful, leads to patchy/variable understanding
  3. DEEP APPROACH
    = making links across material, deeper understanding
38
Q

Describe analytical thinking

A

good at measuring and calculating odds which is the basis of evidence based medicine

39
Q

What are the pros and cons of analytical thinking?

A

pro= reliable, accurate

cons= slows, resource intensive, cognitively demanding

40
Q

Describe intuitive decision making

A

ability to understand something instantly without conscious reasoning

Recognition primed and heuristic (cognitive shortcut that we use all the time)

41
Q

What are the pros and cons of intuitive decision making?

A

pros= fast, frugal

cons= prone to bias and error

42
Q

List the biases of intuitive thinking

A
  1. ERROR OF OVER ATTACHMENT
    confirmation bias, premature closure, sunk costs

2.ERROR DUE TO FAILURE TO CONSIDER ALTERNATIVE
multiple alternative bias, search satisfaction

  1. ERROR DUE TO INHERITING THINKING
    diagnosis momentum, framing effect
  2. ERROR IN PREVALENCE PERCEPTION OR ESTIMATION
    availability bias, base rate neglect, gamblers fallacy
43
Q

How do we reduce the risk of intuition?

A
  1. decision, environment and process
  2. personal debiasing techniques
    e. g. acknowledge bias, slow and stop technique, cognitive forcing strategies
  3. structural debasing
    e. g. training, checklists, group decision strategies
44
Q

Define error

A

unintended outcome

45
Q

How can human error be divided?

A
  1. INTENDED ACTIONS

2. UNINTENDED ACTIONS

46
Q

How are intended errors classified?

A
  1. mistakes
    rule based , knowledge based, skills based
  2. violations
    routine, reasoned, reckless and malicious
47
Q

How are unintended errors classified?

A
  1. lapses
    memory failure, losing place, omitting items
  2. slips
    attentional failures, intrusions, omissions, disordering
48
Q

How are errors classified on outcome?

A 
near miss
death/injury/ loss of function
prolonged intubation/ stay in ICU
cost of litigation
unplanned transfer
49
Q

Which tools can be used to identify risks?

A 
incident reporting
complaints and claims
audit, service evaluation and benchmarking
external accreditation 
active measurement/ compliance
50
Q

List some strategies that can be used to reduce error

A 
simplification/ standardisation of clinical process
checklist
aide memories
team training
risk management programmes
51
Q

What are the 3 key duties of a doctor?

A

KNOWLEDGE, SKILLS AND PERFORMANCE
making the care of your patient your first concern

SAFETY AND QUALITY
take prompt action if you think that patient safety, dignity or comfort is being compromised

MAINTAINING TRUST
be honest and open and act with integrity

52
Q

How can things go wrong?

A 
human error
neglect 
poor performance 
misconduct
system failure
judgement failure
53
Q

List the types of human error

A 
communication
judgement error
omissions, lapses, violations
teamwork problems 
working environment 
decision density
54
Q

List types of neglect

A 
falling below accepted standard 
repeated minor mistakes
necessary care if withheld
safeguarding 
nutrition and personal care 
medical care
55
Q

Describe the features of poor performance

A

a problem with attitude
often rudeness, tardiness, scruffiness and laziness
failure to learn from mistakes and listen to advice
affects patients care

56
Q

List the types of misconduct

A
  1. deliberate harm
  2. lack of candour
    = hiding own or others mistakes, ignoring mistakes, altering medical records
  3. fraud/theft
    = false expense claims, sickness, drug/alcohol problems
  4. improper relationships
    = with patients, relative or colleagues
57
Q

define medical negligence

A

legal entity / outcome of a court case

58
Q

Describe the 4 tests of medical negligence

A
  1. was there a duty of care?
  2. was there a breach in the duty of care?
    Bolam and bolitho test
  3. did the patient come to harm?
    e. g. harm from injury, periods of discomfort, recognised complications
  4. did the breach cause the harm?
    onus on patient to prove it
59
Q

How is a breach in the duty of care assessed?

A

Bolams test = would a group of reasonable doctors do the same?

Bolitho test = would it be reasonable of them to do so?

60
Q

How do courts award costs if their is a medical negligence claim?

A
  1. loss of income
  2. costs of care
  3. pain and suffering
61
Q

Define never events

A

Never Events are serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level, and should have been implemented by all healthcare providers.

62
Q

List some examples of never events

A 
wrong site or implant of surgery
retained foreign object in surgery
suicide
entrapment in bed rails
misidentification
falls from windows
death due to PPH
63
Q

What should happen in a never event?

A
  1. report
  2. investigate
  3. root causes
  4. learn
  5. implement
  6. measure
  7. change
64
Q

What are the mechanisms underlying inhuman behaviour?

A
  1. bystander effect
    e. g. number of bystanders, ambiguity of situation
  2. pressing situational factors can over ride explicitly enouched value systems
  3. conformity
    = unwillingness to speak against prevailing view
  4. ill chose targets
    e. g. 4 hour waiting time

3a GP and public health (3 decks)

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