PPP Flashcards
Lay Referral System
Patients seek advice from family or friends
The Clinical Iceberg
Tip of iceberg – symptoms taken to the GP by patient
Iceberg underwater – symptoms you don’t see
Zola’s 5 Social Triggers
- Perceived interference with physical/vocational activity
- Perceived interference with social or personal relations
- The occurrence of an interpersonal crisis
- Sanctioning
- A kind of temporalising of symptomatology
Mechanic’s Variables that Influence Illness Behaviour
- Visibility, recognisability or perceptual salience of signs
- The extent to which symptoms are perceived as serious
- The extent to which symptoms disrupt family life, etc.
- The frequency of the appearance of the symptoms or signs, their persistence or their recurrence
- The tolerance threshold of those who are exposed to and evaluate the signs and symptoms
- Available information, knowledge and cultural assumptions and understandings of the evaluator
- Basic needs that lead to denial
- Needs competing with illness responses
- Competing possible interpretations that can be assigned to the symptoms once they are recognised
- Availability of treatment resources, physical proximity and psychological and monetary costs of taking action
Kleinman’s Model of Healthcare Systems
Professional Sector – talking to doctors
Folk Sector – traditional medicine
Popular Sector – talking to family/friends
Parson’s Analysis of the Sick Role
Patients want to get well as quickly as possible
Patients should co-operate with the doctor
Patients should shed some normal activities
Patients should be regarded as being in need of care
GMC’s Exceptions for Breaching Confidentiality
- Interest of patient
- Interest of others
- Between healthcare teams
- With the patient’s consent
- Legal proceedings
- Statutory requirements
- Teaching/audit purposes
Bolam Standard and Bolitho
Standard of ordinary, reasonable doctor
Modified by Bolitho, as Bolam could be a low standard
Deontology
Duty based ethics
Respect for autonomy
Allows tell the truth, regardless of outcome
Irrespective of consequences
Utilitarianism
Greater good
Weigh up harms and benefits
In general favours telling the truth and maintaining confidentiality
Assess the best outcomes
The Biopsychiosocial Model
Biological e.g. genetics, virus
Psychological e.g. lifestyle, stress, health beliefs
Social e.g. cultural influences, social support
Patients are not passive victims, but responsible for their own health
Biomedical Model
Every disease has a biological cause
Patient seen as a victim, not responsible for their health
Mind and body are separate entities
Can have psychological consequences but not psychological causes
Health and illness are qualitatively different
Dominant view in past
4 Types of Deception
Involuntary through mishearing/misunderstanding
Voluntary know they’ve misunderstood, don’t clear it up
Intentional when you tell them what you presume isn’t true
Unintentional when you communicate information you think is true, when in fact it’s not
Times conflict can occur
Beneficence v non-maleficence
Professional v relative
Professional v professional
The Health Belief Model
person’s readiness to take health action depends on 4 factors:
The perceived susceptibility of the disease
The perceived severity of the disease
The perceived benefits of taking action
The perceived barriers to performing action
(Demographic variables
Psychological characteristics
Cues for action)
Culture
The customary beliefs, social forms and material traits of a racial, religious or social group
Race
A category of humankind that shares certain distinctive physical traits
Permanent, natural, inherent and genetic
Ethnicity
A large group of people classed according to common racial, national, tribal, religious, linguistic or cultural origin or background
Socially constructed identity
Law of Consent
Patient must give adequate information
Consent must be given voluntarily
Patients must be competent to give the consent
Patient must make a decision
Parental Responsibility
Mother of the child
Father of the child if married to mother
Unmarried father has no automatic parental responsibility
Gillick/Fraser Competence
If a child has sufficient maturity to understand the nature of the medical treatment and its consequences, they are deemed ‘Gillick competent’
Infant Mortality Rate
No. of deaths in children aged under 1/total number of live births x1000
Incidence
Number of new cases/ Population at risk
Prevalence
All cases (old and new) /Population at risk
