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Medicine UOB > PPP > Flashcards

PPP Flashcards

1
Q

WHO Health definition

A

Complete physical mental and social well-being
No disease or infirmity

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2
Q

Sociology health definition (blaxter 1990)

A

Negative -absences of illness and not be able to cope with everyday activities
Positive- fitness and well-being

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3
Q

Symptoms define

A

Those feeling states patient experience to alert them they are not well

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4
Q

Signs define

A

The pointers that doctors identify which signify the existence of the underlying pathological lesio

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5
Q

Stages of illness

A

Experience symptoms
Advice from friends/family
Advice from doctor
Doctor confirms sick
Sick role
Recovery

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6
Q

5 triggers that may cause people to think their ill (zola’s 1973)

A

Interference with work/physical activity (can’t play sport etc)

Interference with social/personal relations (if someone notices and points out)

Occurrence of an interpersonal crisis (losing jobs etc will make symptoms feel worse)

Timings (more than a week I’ll go and see)

Sanctioning (apologising for seeing doctor/someone else asked him to go)

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7
Q

Mechanics (1978) influences to illness behaviour

A

Visibility
Other’s perception to see serious
Disruption if causes
Frequency/persistence
Threshold of those exposed
Knowledge of symptoms/culture pressures
Basic needs that lead to denial/working to get money
Needs competing
Possible interpretation of what symptoms are
Availability of treatment (time, money, effort, stigma)

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8
Q

Parsons and the sick role

A

Patient-
Want to get well quickly
Cooperate and seek medical help
Allow to shed normal activities/responsibilities
Unable to get better on their own

Doctor-
High degree of skills/knowledge
Act for welfare of patient/community
Objective and emotionally detached
Guided by rules of professional practice
Rights:
Allowed to examine physical and personal
Considerable autonomy
Occupies position of authority

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9
Q

Kleinman’s model of healthcare systems

A

Professional- doctors
Popular-self cafe
Folk- alternative medicine

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10
Q

Ethics definition

A

Branch of philosophy
Study of how human beings should behave
Related not to just individual but whole system and society

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11
Q

Sociology definition

A

Social science that seeks to understand all aspects of human behaviour

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12
Q

Biopsychosocial model

A

Look holistically at the person
Bio/psycho/social factors

Criticisms-
Doesn’t look for single factor
Doesn’t focus on illness

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13
Q

Biomedical model

A

Reductionist (simplest process to explain)
Single factor causes
Focus on illness

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14
Q

Stigma model

A

Erving Goffman early 1960s
Set people apart from normal people

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15
Q

Courtesy stigma

A

Members of family stigmatised for affiliation

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16
Q

Managing stigma

A

Depend on how visible
Withdraw

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17
Q

Public health

A

The Art and science of preventing disease prolonging life and promoting health through the organised efforts of society
1988 Acheson WHO

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18
Q

Epidemiology

A

The quantitative study of the distribution, determinants and control of disease in populations

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19
Q

3 types of research studies

A

Cohort design
Case control
Random sized control trial

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20
Q

Definition of clinical communication

A

Any communication that is in a clinical setting
What leads to better outcomes
The means you represent yourself as competently, caring professional

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21
Q

Marx health definition

A

The capacity to do productive work

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22
Q

Parsons health definition

A

A state of optimum capacity for the effective performance of valued tasks

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23
Q

WHO health definition

A

A state of complete physical mental and social well-being
Not merely the a sense of disease or infirmity

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24
Q

Criticism of WHO health definition

A

Pros- emphasis on all three, positive dimensions of health
Cons- is well-being= good health
Utopian

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25
Q

What determines health?

A

Biology
Lifestyle
Environment
Health service

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26
Q

Role of clinical medicine

A

Prevent death
Improve length and quality of survival
Improve quality of life
Preventing and treating genetic disorders
Care

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27
Q

Stigma dictionary definition

A

Mark/spot on skin
Mark of disgrace or infamy
Visible sign/characteristic of disease

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28
Q

Goffman 1963 definition of stigma

A

An attribution that is deeply discrediting
reduces from a whole and usual person to a tainted discounted one

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29
Q

Stigma

A

Social interaction
Focus on individual
Visible or known difference
Negative

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30
Q

Prejudice

A

Social cognition
Focus on group
Attitudes or emtotions
Negative

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31
Q

Stereotype

A

Social cognition
Focus on group
Social expectations
Positive negative or neutral

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32
Q

Causes stigma

A

Undesirable characteristics decided by society

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33
Q

Effects of stigma

A

Will cause labels to spread faster (especially when people in power will say them)
Emotional reactions to people (fear, repulsion)

People who are stigmatised- shame, status lost, discrimination

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34
Q

How to help people who are stigmatised?

A

Special care for those with visible health conditions (changing faces)
May delay seeking help as stigma

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35
Q

Examples of stigmatised conditions

A

Visible differences
Mental health
Infectious disease
Feared conditions (contagion)

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36
Q

Why is there stigma about cancer?

A

Incurable
Unclear -> more frightening
Can lead to visible differences (hair loss etc)
Potentially embarrassing outcomes (colostomy bag etc)

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37
Q

Three types of stigma from Goffman

A

Abomination of the body - physical disfigurement/deviation from social norm

Blemishes of character - a known record (eg alcoholism) seen as a character flaw

Tribal identities - negative evaluation of people due to association with particular group

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38
Q

Impact of physical stigma

A

Heightened social anxiety
Embarrassment
Depression
Low self esteem
Social withdrawal
Isolation

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39
Q

Stigmatised activities eg
(Linked to a person character)

A

Drug/alcohol addiction
Time spent in prison
Long term unemployment
Sex workers
Mental illness
Sexuality

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40
Q

Scambler 2009 -> shame or blame

A

Seen as innate or genetic and as in control

Is something predetermined or is it a choice

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41
Q

Types of tribal identities

A

Religious groups
Radical groups
Ethnic groups
Chosen ie -> clothing, symbols (goths)

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42
Q

Impacts of stigma (Goffman)

A

Change social identity

A person is discredited -> sign that cannot be disguised

Discreditable -> when possible to conceal but showing

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43
Q

Discredited individuals effects

A

Enacted stigma -> staring, avoidance
Effects on earning potential/employment
Isolation -> felt stigma

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44
Q

Discreditable individual effects

A

Concealment stratgies
Passing as normal

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45
Q

Spoiled identity (goffman)

A

An individuals social identity is dominated by the stigmatised illness/attribute

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46
Q

Response to spoiled behaviour

A

Pass as normal
Information control
Avoiding social contact
Trying to avoid blame
Refusing to be ashamed

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47
Q

Stigma vs stereotype

A

Both viewed differently to what they are

Stereotype:
Group identity

Stigma:
Individual and effect on them

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48
Q

Prejudice vs stigma

A

Prejudice: attitudes/negative emotions towards groups
Focuses on the person holding the prejudice
Can lead to discrimination

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49
Q

Examples of prejudice (2)

A

Race
Ethnicity
Mental health
Self harm

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50
Q

Three phases of decision making (to make the best possible)

A

Gather info
Recalling and pooling that info
Weighing things up

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51
Q

Decision making is adversely affected by

A

You weren’t competent

You were coerced or under pressure to make it quickly

You were deceived or had info concealed from you

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52
Q

Decision making is a…

A

Joint enterprise between doctor and patient

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53
Q

Autonomy (bullet points)

A

Takes roots from humanism

-ownership of the self

-person has right to determine their experiences

-persons should not be made to do things against their will/interests

-a person should not trepass on the person of another

Patient centered

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54
Q

Autonomy basics

A

self determination
Personhood
Identity
Integrity

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55
Q

Battery

A

Treating with no consent

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56
Q

Self determination theory

A

With human motivation links with well being, satisfaction and performance autonomy, competence, relatedness

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57
Q

The best decisions possible (gmc)

A

All patients have the right to be involved in decisions about treatment, care and be supported to make informed decisions

Decision making in an ongoing process on meaningful dialogue- the exchange of relevant info

All patients have the right to be listened to and given info they need/time and support to understand it

Doctors must try to find out what matters and give relevant info and alternatives that are reasonable (including doing nothing)

Presumption that all adult patients have the capacity to make decisions

Choice of treatment or care for patients who lack capacity must be of overall benefit

Someone’s who’s right to consent is affected by law should be supported and involved

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58
Q

Law around consent

A

Based around case law. What previous judges in similar cases

Not enacted through parliament (legislation)

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59
Q

Sidaway vs Bethlehem 1985

A

A doctor who operates without the consent of his patient save in cases of emergency or mental disability, is guilty of the civil wrong of trespass to the person, he is also guilty of the criminal offence of assault

To provide enough info for the patient to make a balanced judgement
Provide alternatives
Inform of common/serious consequences

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60
Q

How much info to give?

A

Depends what you’re proposing (abdo exams very little etc)

How much info your patient wants

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61
Q

Montgomery vs Lanarkshire (2015)

A

Chose not to tell the patient about the risk of shoulder dystocia in large baby, small diabetic mum
Baby did suffer oxygen deprivation causing cerebral palsy

Supreme Court ruled the doctor should have informed

Have to tell any material risks and any reasonable alternatives

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62
Q

What is a material risk?

A

Whether a reasonable person in the patients position would attach significance to the risk

If the doctor knows (or should know) that this particular patient would attach significant risk to

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63
Q

GMC material risks

A

Clear accurate and up to date info
About the potential benefits and risks of each option including nothing

No reasonable to share every possible risk- instead tailor to patient guided by what matters to them

  1. Recognise risks of harm that anyone in their position would want to know
  2. Effect of individual circumstances of the probability of a benefit or harm
  3. Risk of harm that this patient would consider significant
  4. Any risks of serious harm- death etc
  5. Expected harms, common side effects and what to do if they occur
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64
Q

Is consent always necessary?

A

Can use implied consent

Must not assume the patient understands what you are about to do

Best practice to ask

Sometimes cannot consent (emergency etc) in these situations act in best interests

Use info about what they would want if available (advanced directive)

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65
Q

Is consent always valid?

A

Can expire-prolonged time or situation changes
If conditions not met then not valid
Must be: voluntary, informed, competence

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66
Q

Onus on doctor to ensure consent valid

A

Make sure:
Voluntariness- free will (pressure or vulnerability)

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67
Q

Beauchamp and Childress 1994

A

Coercion occurs if and only if one person intentionally uses a credible and server threat of harm or force to control another

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68
Q

Coercion

A

Depends on accuracy of information

It is exaggeration to persuade

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69
Q

Parental consent

A

Those with parental responsibility can consent on behalf of children who have not yet achieved competence

Mothers have parental responsibility for any child given birth to
Fathers have pr if named on birth certificate or if are married to the child’s mother
Can apply for pr through courts
Adoptive parents gain legal pr
Social care can also have pr

Only need one parent to say okay

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70
Q

Parental refusal

A

One parent cannot veto a treatment of other parent agrees
If one parent doesn’t want and one gives consent- best to work in best interest

If both disagree- can apply to court of law if needed treatment, will consider parents belief but to safeguard child

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71
Q

Children’s act 1989

A

Duty to maintain the child’s welfare as paramount

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72
Q

Why measure the health of the population?

A

Prevalence
Incidence
Identify longitudinal trends
Interventions or policies helping?
Disease patterns
Service planning

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73
Q

Prevalence

A

How common a disease is at one point in time
good for: ascertaining burden of long term conditions

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74
Q

Incidence

A

How many new cases occur
over a period of time

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75
Q

Data sources for measuring health status

A

Death certificate
Census
Health survey for England
Hospital episode statistics
General practice research databases (CPRD, THIN)
Health protection reports of notifiable infectious diseases
Cancer registration
National/local/regional audits

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76
Q

Death certificates, what info?

A

Legal requirement to register
Age
Sex
Occupation
Cause of death and contributing diseases

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77
Q

Census, what info?

A

Every 10 years
Counts everyone in household
Age
Gender
Migration
Education
Marital
Health
Housing conditions
Family
Employment
Travelling habits

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78
Q

Hospital episode statistics, what info?

A

All outpatient appointments/admissions
Diagnoses and operation
Age
Gender
Ethnicity
Time waited
Date of admission
Geographical info of where treated
Outcome of treatment

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79
Q

Clinical practice research datalink used for…

A

Clinical research planning
Drug utilisation
Studies of treatment patterns
Clinical epidemiology
Drug safety
Health outcomes
Health service planning

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80
Q

Health survey for England includes

A

Questionnaire answers on- smoking, demographic, self reported info on health, illness, treatment, health service usage
Blood+saliva sample analysis
Height
Weight

Key theme each year: asthma etc
Freely available online

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81
Q

General lifestyle surgery includes

A

Whole of GB
Demographic info of families
Housing tenure and household accommodation
Access to vehicles
Employment
Education
Health and use of health services
Smoking and drinking
Family info- marriage, fertility

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82
Q

Notifiable diseases used for

A

Can be by doctors or lab results
Cancers registered in cancer registries and linked to data

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83
Q

Methods to measure health and disease

A

Birth and fertility rates
Incidence
Prevalence
Mortality

84
Q

mortality data advantages

A

legal requirement
little delay
ensures comparability (international classification of diseases)
cheap sources of data

85
Q

mortality data disadvantages

A

potential for error
death may be from a conjunction of diseases
some diseases have high mortality rate and death occurs quickly- others long term and resources intensive

86
Q

why we use mortality and morbidity rates?

A

compare areas
-areas with poor health
-if need preventative services
-may raise a cause of disease

look at change over time

87
Q

what is the international classification of disease?

A

providing a format for reporting causes of death on the death certificate

88
Q

direct standardisation definition (Age)

A

age specific death rates from a study population are applied to a standard population structure

google: the rate that we would expect to find in the populations under study if they all had the same composition according to the variable which effect we wish to adjust or control (age)

89
Q

direct standardisation advantages

A

used to compare disease rates across areas and time
assess relative burden of disease in a population

90
Q

direct standardisation disadvantages

A

requires age specific rates (not always available)
rates may not be stable if a small population

91
Q

indirect standardisation definition

A

age specific rates from a standard population are applied to a study population =standardised mortality ratio

92
Q

standardised mortality ratio equation

A

observed number of deaths for study population/expected number of deaths for study population

93
Q

indirect standardised advantages

A

no local rates needed
easier to interpret rates

94
Q

disadvantages of indirect standardisation

A

areas cannot be directly compared (only within the UK for example)
does not give an idea of actual burden of disease (no 1 in 100)

95
Q

what goes wrong in interpreting?

A

different criteria for the symptoms of a disease
not all cases have been identified
use of hospital data for disease/death, omits those in gp or community

96
Q

people living in high deprivation have…

A

lowest life expectancy at birth
highest death rates
highest teenage pregnancy
higher levels of unhealthy lifestyles

97
Q

5 theories why health associated with deprivation

A

an artefact of measurement error
social selection (health determines socioeconomic status, not the other way round)
behavioural/cultural
psychosocial (stress of low status job causes biological changes)
material/structural conditions (direct effects)

98
Q

more recent theories of health and deprivation

A

importance of area context- availability of goods, facilities, social availability
role of lifecourse- pathways between childhood and adulthood that accumulate risk for health

99
Q

karl marx definition of health

A

a commodity
the capacity to do work

100
Q

talcott parsons definition of health

A

the state of optimum capacity of an individual for the effective performance of the roles and tasks for which they have been socialised
capacity to do productive work

101
Q

what uses the deficit based model for health?

A

the traditional medical model
the body is a machine to be fixed

opposite= asset based model

102
Q

criticisms of WHO model

A

is it realistic? are we unhealthy most of the time?
temporal changes in the burden on illness? acute>chronic
temporal changes in spells of ill health?
those with chronic or disabilities?
culturally applicable?
how is it even measured?

103
Q

objective wellbeing measured based on…

A

assumptions about basic human needs and rights
-food, physical health, education, safety
through self report or objective measures like mortality rates etc

104
Q

subjective wellbeing measure by…

A

asking people directly how they feels about their own wellbeing
-about life satisfaction, meaningful, positive emotions

105
Q

biological factors that effect health

A

age
sex
genetics
ethnicity (bio differences, social inequities- racism= effects on health care, cultural- family, diet)

106
Q

lifestyle factors that affect health

A

smoking
nutrition
alcohol
physical activity
risky behaviours
obesity

107
Q

environmental factors that effect health

A

more fast food chains in deprived areas
housing- poor quality, overcrowded
access to good green space
air pollution
transport- road accidents
education
unemployment

108
Q

role of clinical medicine in health

A

preventing disease
improving length and quality of survival in fatal conditions
improving quality of life in non fatal conditions
preventing and treating genetic disorders
care
(not always medicine- evidence for lifestyle decreasing diseases dramatically before vaccines even introduced)

109
Q

how are disease classified?

A

international classification of diseases
diagnostic and statistical manual of mental disorders
diagnoses on electronic patient records
draws on medical consensus building

110
Q

who classifies disease?

A

WHO
American psychiatric association
read codes- GPs

111
Q

what is a social construct?

A

an idea that has been created and accepted by the people in a society

112
Q

define medicalisation (conrad 2007)

A

the expansion of medicine into areas that are considered non-medical
can be:
conceptual- use of medical terms
institutional- doctors used as gate keepers, eg legitimising sickness
interactional- direct interaction, eg prescribing for a social problem

113
Q

define iatrogenesis

A

doctor caused disease
medical iatrogenesis- illness caused or made worse through treatment, eg cascade prescribing
social iatrogenesis- medicalisation
cultural iatrogenesis- ability to cope with illness and death is eroded by handing over to professionals

114
Q

examples of behaviours that have been medicalised?

A

use of medical terms in the media
doctors signing off people from work
being prescribed medication for a social issue

115
Q

examples of conditions where construction plays a major role

A

effects of diagnosis/labelling

116
Q

marinker’s definitions of:
disease
sickness
illness

A

disease- deviation from biological norm, viewed objectively, individuals experience in the background

illness- experience of unhealth which is entirely personal
often felt together

sickness- social position of a sick person, different social status

117
Q

WHO health definition pros

A

emphasis on all three facets
positive dimensions of health

118
Q

WHO health definition cons

A

is well-being good heath?
utopian

119
Q

incidence rate equation

A

(number of new cases of a disease arising over a period of time)/(person-years at risk)

120
Q

person years at risk equation

A

total population x time period

121
Q

point prevalence equation

A

number of people with a disease at a point in time/ total population at risk of the disease at the time point

122
Q

birth rate is…

A

number of live births per 1000 population

123
Q

general fertility rate is…

A

number of live births per 1000 women aged 15-44

124
Q

why is total fertility rate better than general fertility rate?

A

takes into account age structure between populations, so allows for comparison

125
Q

total fertility rate is…

A

the average number of children that a woman would bear if they experienced the age specific fertility rates at that point in time

126
Q

infant mortality rate equation

A

number of deaths in children ages <1 year x 1000
_________________________________________
all live births

127
Q

why measure infant mortality rate?

A

correlated to life expectancy
amenable to change through public health measures

128
Q

crude mortality rate equation

A

total mid year population

129
Q

disease specific death rate equation (per 1000)

A

total mid year population

130
Q

standardisation define

A

enables us to compare rates of disease or death in populations with different structures

131
Q

describe culturally based differences in approaches to death

A

Hindu patient- sleeping near to floor when dying
Muslim funeral- buried never cremated, funeral as soon as possible, body is washed
Sikh- as soon as possible, cremation, coffin first to family home, duty of heir to light (here press button)

132
Q

discuss how social sciences approaches can explain why and how people engage in death rituals

A

Group com my together
Remembering the dead
Tradition
Comforting
Gives an important role to dead’s family
Can be linked to religion

133
Q

give examples for situations where medical professionals engage with culturally diverse death rituals

A

Allowing to be close to floor
Trying to make the process as quick as possible

134
Q

What is culture?

A

Groups and their customs/traditions
Learnt or taught but often unspoken

Overlap with ethnicity, nationality and religion

135
Q

Medicalised death

A

Interrupt natural death
Negotiation between family and doctor about what is desirable
Palliative care

136
Q

Cultural competence training is…

A

Being culturally sensitive
But focuses on one individual while this is embedded in the system

137
Q

The asked model of cultural competence stands for? (Campinha-bacote 2003)

A

Awareness
Knowledge
Skill
Encounters
Desire

138
Q

Discuss the ways people define health and illness (Boyd 2000)

A

Disease- pathological process
Illness- patients experience
Sickness- role played in society
Healing and wholeness- whatever process results in the experience of greater wholeness of the human spirit

139
Q

Recognise the different ways in which people seek and interpret medical advice and information through formal healthcare settings and lay sources

A

professional sector
Folk sector (alternative)
Popular (media)

140
Q

Understand how people make decisions about approaching the formal healthcare system and the factors which influence this

A

Symptoms
More visible or impact on daily life
Family member pointed out
Personal Crisis
Effecting hobbies

141
Q

Discuss the factors which influence peoples use and experiences of health care

A
142
Q

Kleinmans model of healthcare systems includes…

A

Professional sector
Popular sector
Folk sector

143
Q

Utilitarianism define…

A

Maximise happiness for the most people possible
Reduce suffering
Depends on outcome not act itself

144
Q

Would a utilitarian tell the truth?

A

If it would lead to a good outcome
Should lie if not

145
Q

Advantages and disadvantages of utilitarianism

A

✅Initiative
Distribution of Justice
Flexible-no rigid rules

❌consequences hard to predict
Can be hard to measure consequences/far reaching
No intrinsic value in the system
Can be unfair to favour majority
One person may be more valuable

146
Q

Deontology define…

A

Rational beings so are capable of deciding what our moral duties are

Not about outcomes
Actions are either wrong or right
Can generate rules to always be right

147
Q

Deontology advantages and disadvantages

A

✅humans are not expendable so should not be sacrificed for the majority
Reflect on how people perceive mortality
Places value on intention
Offer certainty that you are right

❌ too rigid
Can cause immense suffering just to stick to a principle
Often conflict of duty
Not that rational as humans (have emotions and pre-existing morals)

148
Q

Beau champ and childress (1979) four principles are…

A

Beneficence
Non-maleficence
Justice
Autonomy

149
Q

What does objective or rational mean?

A

Without emotion

150
Q

Virtue ethics (Aristotle)

A

Based on a mentor role
Cultivate a good moral character
Phronesis - experience/practical wisdom

151
Q

Virtue ethics pros and cons

A

✅pretty accurate to what most people currently do
acknowledge complexity
Most people have role models
Developmental model- doesn’t expect perfect but imperative to improve

❌nebulous (doesn’t help with decision making as vague)
Often pick role models who are like yourself
Virtuous character can take years to develop
Self-centred, what about the patient?
Encourages perfectionism
Role-model based

152
Q

Different views of telling truth
(Utilitarian, deontology, 4 principlism, virtue, communitarian)

A

U: if increases happiness
D: because it’s your duty
P: enables autonomy
V: what a good person would do
C: allows us to trust each other

153
Q

Communitarianism define

A

Need all the building blocks to complete a successful society

Ethics- trust- needs- well-being- collaboration

154
Q

NHS guidelines for truth telling

A

NHS: Probity means being honest and trustworthy, acting with integrity

GMC: act with honesty and integrity

155
Q

Every day deception- Micheal Lewis

A

Total honest would pose a significant Dias advantage
Being about to conceal feelings and stimulate others is considered a key part

156
Q

The truth that is due- Hugo grotois 1625

A

Only owe the truth that is due
A lie is not wrong if someone had no right to the truth

157
Q

Types of deception

A

Lie of commission
Lie of omission
Lie of embellishment

158
Q

Lie of commission define…

A

A direct statement of an untruth

159
Q

Lies of omission define..

A

Omitting to tell someone something that would materially effect their understanding of the situation

Grey area
Eg Not telling someone that their partner has a communicable disease

160
Q

Nocebo effect

A

Experience a side effect of it has been told to them

161
Q

Lies of embellishment define…

A

An exaggeration or misrepresentation to generate a misleading interpretation of a situation

162
Q

The last resort (Sissela Bok 1978)

A

Truth has value
Lies do not
So to outweigh the trust, you need multiple other factors to be sufficient

163
Q

What caused the duty of candour?

A

The mid staffs scandal

164
Q

What is the duty of candour?

A

Be honest with your patients about mistakes or errors that have happened in their care

Volunteered info not requested for

Have duty to:
-inform people about the incident
-provide reasonable support
-provide truthful info
-provide an apology

165
Q

Patient priorities are…

A

Humaneness
Competence/accuracy
Patient involvement In decisions
Time for care

166
Q

What is Clinical communication?

A

The means through which you represent yourself as a competent, caring health care professional

Any communication in a clinical setting

167
Q

What under pins competence in clinical communication?

A

Knowledge
Character
Skills

168
Q

Why is reflective practice good?

A

Prepares you for ill-defined and complex issues
Think about past actions
Create and clarify meaning in terms of self but examining responses and emotions
Informs your actions for future experiences

169
Q

Gibbs model for reflection

A

Description
Feelings
Evaluation
Analysis
Conclusion
Action plan

170
Q

Define stigma

A

A mark of disgrace or infamy (dictionary)

Goffman- 1963: an attribute that is deeply discrediting, dedicated the bearer from a whole and usual person to a trained and discounted one

171
Q

Explain goffman’s formulation of stigma

A

?
Impact of label
Causes shame, status loss, discrimination

3 types: abominations of the body
Blemishes of character
Tribal identities

172
Q

Give examples of how specific medical conditions can be stigmatised in different ways

A

Mental health
Infectious disease
Feared conditions
Visible differences

173
Q

The effects of living with a stigmatised condition

A

Enacted stigma- staring
Effects on employment
Isolation

174
Q

Roles of hcp in dealing with the effects of stigma

A

May prevent people from seeking help earlier

175
Q

Re T situation

A

Refusal of a blood transfusion, but then deteriorates- new situation so refusal was different and so best interests

Judge said about undue influence:
Doctors must consider whether the decision is really that if the patient

176
Q

Consent must be…

A

Informed voluntary and capacitous

177
Q

Why is autonomy a spectrum?

A

Material or social conditions - ie jobs can effect what decision you make

Must have a stable sense of self and value

178
Q

Individualism

A

The role of a society is to maximally endow its citizens with the ability to make autonomous decisions

Cons- the wishes can be conflicting, so it may be unfair to others, constantly competing

179
Q

If capacity is lost, then which of the four principles is gone?

A

Autonomy

180
Q

To have capacity, a patient must be able to…

A

Understand the presented info
Retain the info
Weigh up the decision
Communicate that decision

181
Q

Is capacity variable? Does it change for each decision?

A

Yes
Never assume someone doesn’t have capacity
For each decision, it should be assessed
Provide all possible help and support

182
Q

What are the signs that someone doesn’t have capacity?

A

Erratic decision making
A conditions that could affect their ability

183
Q

The two stage test of capacity

A

Stage 1-
Is there an impairment of/disturbance in the functioning of a persons mind or brain?

Stage 2-
Is the impairment sufficient that the person lacks capacity?

184
Q

What are the different types of impairment that can stop capacity?

A

Disorders of the brain- strokes/brain damage/learning difficulties
Temporary- shock, fatigue, pain, drugs, panic

185
Q

Capacity is…

A

Dynamic
Independent of whether you agree
To chose between, or refuse offered treatments
Cannot just ask for a treatment

186
Q

The mental capacity act (2005)
Who is it for?

A

Over 16
Lack capacity to make some or all decision for themselves

187
Q

What are the 5 principles of the mental capacity act?

A

Presumption of capacity
Support of individuals to make decisions
Unwise decisions
Best interests
Least restrictive option

188
Q

What to do if your patient doesn’t have capacity? Who to talk to?

A

Decide what is overall benefit
Consult with those close to the patient
Or those in the health care team
Get an agreement of those people
Consider which option aligns closely with patients needs
Consider options would be least restrictive of the patients future options

189
Q

What to consider when deciding options with no capacity?

A

Can it wait? Will the regain capacity?
What is best in general?
What is best for this specific person?
Can you get any more info?

190
Q

Advanced statement, what is it?

A

Any info which the patient feels is relevant to their future care, should they lose capacity to make their decisions

191
Q

Advanced decision, what is it?

A

Only to the advanced decisions to refuse certain treatment in specified circumstances

192
Q

What makes an advanced decision legally binding?

A

In writing
Signed by the patient
Signed by a witness
Only circumstances and treatments specified

193
Q

What are the two types of lasting power attorney?

A

Health and welfare
Property and financial affairs

194
Q

How’s does a lasting power of attorney work?

A

Legal doc
Allow named person to make certain decisions

Next of kin does not have right without LPA

195
Q

What happens if you have no friends or family and no capacity? Who can you turn to?

A

Independent mental capacity advocates

196
Q

What are the guidelines for the independent mental capacity advocate?

A

Over 16 years old
Long term change in accom or serious medical treatment
Lacks capacity
No on independent of services who is appropriate to consult (friends of family)

197
Q

What do the court of protection do?

A

Make decisions on whether someone has mental capacity
Handling best interest disputes
Ruling on questions about deprivation of liberty
Can apoint deputies (longstanding of lack of capacity and no LPA)

198
Q

Competence

A

Minors under age of 16
Whether they have ability to make autonomous decisions about their health

Not interchangeable with capacity
Don’t use incompetent

199
Q

Gillick v West Norfolk & Wisbeck Area Health Authority (1986)

A

Led to Gilick competence
Children under 16
Can consent if they have sufficient maturity and intelligence
To fully understand proposed treatment, purpose, nature, likely effects, risk, chances of success

200
Q

How to determine the maturity of a child?

A

Child’s experiences and ability to manage influences in their decision

Ie peer pressure, family pressure, fear and misgivings

201
Q

How to measure a child’s intelligence?

A

Child’s understanding
Ability to weigh risk and benefits
Consideration of long term effects

202
Q

Fraser guidelines apply to?

A

Contraception
Or termination of pregnancy
And treatment of STIs

203
Q

What are the Fraser guidelines?

A

Sufficient maturity and intelligence
Understand nature and implications
Cannot persuade to tell parents or allow doctor to tell parents
Very likely to continue sex
Physical or mental health could suffer without treatment
Advice is in best interest

204
Q

If they are not gillick competent?

A

Seek parents consent
Usually on parents consent is enough
If parents cannot agree then seek legal advice

205
Q

Scope of parental responsibility (2015)

A
  1. Is this a decision that a parent should reasonably be expected to make?
  2. Are there any factors that might undermine the validity of this particular persons parental consent?
206
Q

Can a parent override the competent consent of a young person?

A

No

207
Q

Can a competent refusal be overruled by a parent?

A

Yes
Technically A parent but is now a dwindling right, courts Will hesitate to enforce so always seek legal advice

But yes court

Medicine UOB (8 decks)

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