PPP Flashcards
What is the test of Materiality? [2]
- Whether a reasonable person in the patient’s position would attach significance to the risk.
- If doctor knows (or should know) that this particular patient would attach significance to the risk.
What is the difference between Coercion and Persuasion?
Persuasion requires understanding. Coercion requires only power
Regarding law and consent, what did the Sidaway vs Bethlem Royal Hospital Governors 1985 entail?
- Medical Negligence
- duty of a surgeon to inform a patient of the risks before undergoing an operation.
-Patient had 1% chance of paralysis, Doc did not inform as he felt risk was not substantial. Patient sued. Judge determined negligence. - Duty to provide enough info for the patient to make a balanced judgement
- Should provide alternatives
- Should inform of “common or serious” consequences
What is implied consent and give 3 examples.
Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place – for e.g, holding out an arm for a blood test, removing a shirt to allow for use of stethoscope.
Define Birth Rate
is number of live births per 1000 population
General Fertility Rate
is number of live births per 1000 women aged 15-44
Total Fertility Rate
is the average number of children that a women would bear if they experienced the age-specific fertility rates at that point in time
Prevalence
is proportion of people in a population of a known size who have a particular disease at a specified point in time
Incidence
is the number of new cases over a period of time in a population of a known size
Concordance
The extent to which a patients behaviour matches what has been agreed with a healthcare professional
Define Negligence
Obtaining consent on the basis of inadequate information about side effects, risks and treatment alternatives and then harm being caused
Define Battery
Treating someone without consent.
Harmful or offensive touching of the body.
Define Interactional Level of Medicalisation
Dr–patient interaction when a social problem is defined as a medical one & medical treatment occurs
Define Conceptual Level of Medicalisation
medical vocab used to define a problem, signs and symptoms become medicalised e.g. ADHD, Dyslexia etc.
Define Institutional Level of Medicalisation
when organisations adopt a medical approach to treating a problem e.g. alcoholism, mental health, pregnancy and child birth
What is Iatrogenesis
the harm caused by iatrogenic effects (effects of treatment) of intervention e.g. side effects of drugs, secondary infections in hospitals or negative clinical consequences of surgery.
What is Complementary Medicine?
Non-mainstream practice is used together with conventional medicine. E.g cancer patient receiving acupuncture alongside chemotherapy
What is alternative Medicine?
non-mainstream practice is used instead of conventional medicine e.g cancer patient refuses chemotherapy and relies on complementary medicine. Even alternative can be used in complementary setting
What does CAM stand for? Definition?
Complementary & Alternative medicine.
A group of therapeutic & Diagnostic disciplines that exist largely outside the instituions where conventional healthcare is taught and provided
What is integrative medicine?
Where both patients & HCPs are onboard with the use of conventional and complementary treatments
What is Pluralism?
System where more than one route of treatment is offered in healthcare to the patient i.e GP would offer both an orthodox treatment route and an alternative treatment route for the patient to decide
What are the 5 groups of complementary medicine?
- Mind-body medicine – techniques designed to enhance the mind’s capacity to affect bodily function & symptoms i.e. meditation & prayer
- Manipulative & body-based practices – movement of one or more body parts i.e. chiropractic, osteopathy and massage
- Alterative medical systems – built on complete systems of theoretical principles & practice i.e. homeopathy & traditional Chinese medicine
- Natural products - e.g use of natural substances e.g. herbal products etc.
- Energy medicine – medicine that effects the energy fields that supposedly surround and penetrate the human body e.g. bioelectromagnetic-based therapies, Reiki, therapeutic touch.
House of Lords classified CAM therapies in 2002 [4]
Most popular therapies with most evidence are in G1. Popularity and evidence base decreases as you go down
Group 1 (i.e. acupuncture, chiropractic, osteopathy, homoeopathy, herbal medicine e.g. St John’s Wort) – have a diagnostic approach i.e. take a history to develop a management plan specific for you.
Group 2 (i.e. aromatherapy, hypnotherapy & meditation) – these are most commonly used to complement conventional medicine, don’t have diagnostic skills
Group 3a (i.e. traditional and herbal Chinese medicine), philosophical approach.
Group 3b (i.e. dowsing and iridology) – no evidence for these
What are examples of CAMs?
Homeopathy, herbal medicine
Alexander Techniques (analysing posture) for Parkinson’s
Ginger and acupressure to reduce morning sickness in pregnancy
Hypnotherapy (NICE advises for refractory irritable syndrome)
Dowsing (two pronged twig quivers to identify site of problem)
Iridology (diagnose based on colour of patient’s iris)
TCM (Not much research as it is not in english)
CAM Avg user characteristics
Female (when in menopause)
Middle aged
higher socio-economic groups
Higher level of education
Regional differences
Ethnicity
Different patterns of complementary medicine usage (users and seekers)
Earnest seekers: Chronic health problem, tried many therapies including CAMs
Stable users: either using one type of therapy for most/all healthcare problems or range of therapies for one main problem
Eclectic users: Choose and use different therapies for different problems
One-off users: Discontinue complementary therapy after limited use.
Factors causing growth of CAM
Dissatisfaciton with orthodox medicine
Long wait time for appointments
Postmodern philosophy rejection (Prefer natural products and concerned about side effects from modern medicine)
Widespread availability of CAMs
Increase in consumerism
Increase of individual responsibility
Positives of CAMs
Accessibility (less wait time, less stress)
High touch, low technology
More control over treatment
Pleasant therapeutic experience
Perceived effectiveness and safety
Good patient-therapist relationship
Noninvasive nature (except acupuncture)
Affluence (people have money to spend on this treatment)
Negatives of CAM
Dissatisfaction with some aspects of orthodox medicine
Ineffective for certain conditions
Serious adverse effects
Poor Dr-patient relationship
High tech, low touch
Rejection of science and technology
DESPERATION - if orthodox not working, turn straight away
Potential controversy of CAMs
Effects on Dr-patient relationship (lack of disclosure)
Adverse effects/interactions with orthodox treatment
Evidence based CAMS - placebo effect, cure vs feeling better
CAM therapist would have had shorter training
Equality Act defined which 9 protected characteristics
Age
Race
Sex
Disability
Marriage and Civil Partnership
Religion
Gender confirmation and identity
Sexual Orientation
Pregnancy and Parenthood
Equality vs Equity
Equality involves giving everyone the exact same resources irrespective of their needs i.e., everyone has the same starting point.
Whereas equity involves distributing resources based on the needs of the recipients i.e., everyone can have the same finishing line
Define Harassment
Any action taken to degrade or humiliate someone in an interaction
Define Victimisation
Treating someone badly due to them making a complaint of discrimination
How can you be discriminated based on your age?
Employment, promotion
competition with other age groups
Not as productive
Access to healthcare
COVID:
Equality - Distribute vaccine among everyone equally irrespective of susceptibility
Equity - Vaccines first given to elderly as they are more vulnerable
How can you be discriminated racially?
Skin Colour
Nationality
Ethnic Group - Black and ethnic minorities are less likely to get treatment. Increased risk of COVID
How can you be discriminated based on sex?
Women mainly facing this (pay gap, misogyny)
Undermining a colleague because it’s “that time of month”
Harassment: Action, verbally, implicitly, via social media
COVID: more women lost jobs
How can you be discriminated against gender?
Being treated disadvantageously because
But it is foundational to people’s identities
Lots of ways to express gender identity
Gender Recognition Certificate
How can you be discriminated against pregnancy and parenthood?
Being treated unfairly because you are pregnant, breastfeeding or recently given birth
Affected by COVID especially regarding bereavement or having partners there
How can you be discriminated religiously?
Often it is association rather than directed
Even within religion e.g Christianity
How do you get discriminated regarding disability?
Physical or mental impairment
PTSD which impact ability to work and find job
Most disabilities are hidden
Intersectionality
Don’t think about things in isolation
Single issue struggles do not exist
E.g Black woman who is muslim
Picking out where prejudice comes from can be difficult
Patient compliance/adherence
Taking medication as directed
Keeping medical appointments
Why might patients not comply?
Fear of side effects, fear of dependency, treatment not fitting with lifestyle, forgetfulness, feeling well, too busy, travel away from home, etc.
How to improve adherence?
Tell Pt what you are about to tell them
Stress importance
Repeat instructions
Do not overload
Give specific advice
Encourage patient to take notes
Use simple words
Theory of planned behaviour in alcohol
Limited availability through taxes
Minimum purchase age laws
Limiting hours of the day and sale
Regulation of drinking environments
Drink driving countermeasures
Primary, Secondary, Tertiary prevention
e.g with diabetes
Education (undertake physical activity, eat sensibly)
Dieting (prevent complications, good blood pressure control)
Treat problems (prevent death or permanent disability)
Name barriers within health beliefs and culture
Constraints to taking exercise: “many of the female
subjects rarely left the house, apparently through fear of
physical attack. Some … lived in high-rise flats with no
working lift, and some commented on the absence of
parks, dirty pavements, and street crime.”
Name Cues for action within health beliefs and culture
Most appeared to believe that in the absence of
symptoms, diabetes is well controlled. The need for
regular surveillance when asymptomatic was rarely
acknowledged
Acute vs Chronic
