PPP Flashcards
COMMUNICABLE SKILLS OF A DR
- empathy
- honesty
- openness
- support
- share knowledge
EPIDEMIOLOGY
study of distribution, determinants & control of disease in pop.
COHORT RESEARCH
- tells us risk of developing condition & prognosis (what happens)
- expose some to disease & not to others
WHY RANDOMISE CONTROLLED TRIALS
ensures groups are similar & lower effect of risk factors
BIOMEDICAL MODEL OF DIAGNOSIS
- one universal cause of illness (e.g. not looking at genetic factors etc)
- assumes people aren’t responsible for their health (e.g. smoking & alcohol = no impact on disease)
- only explains illness simply e.g. as disordered cells
- research based on causal functions
BIOPSYCHOSOCIAL MODEL OF DIAGNOSIS
- holistic approach (looks at every level of explanation)
- people behaviour influences their health, understands that illnesses have many causes
- looks at biological factors, psychological factors & social context
WHY DRS MUST BE ETHICAL
- increased need (patients at most vulnerable)
- medical power (we know info & patient must trust us even though relationship is unbalanced as patient faces consequences of poor choice)
- decisions (decisions we make have impacts on individuals & society e.g. end of life)
WHY MEASURE POP. HEALTH
identify prevalence (how common), incidence (new cases), difference in patterns between different population groups
PROS OF MORTALITY DATA
cheap, international disease classification allows comparability
CONS OF MORTALITY DATA
- death may be due to many diseases together, potential for error (coding & processing)
INCIDENCE RATE
(number of new cases of disease over time period) / (total population at risk x time period)
PREVALENCE
number of people with disease / total pop. at risk of disease
WHY HEALTH IS RELATIVE
societies differ in their beliefs of cause of medicine & have different models for understanding it
CRITIQUES OF BIOMEDICINE
- MEDICALISATION - non-medical issues become defined & treated as medical e.g. stress & alcoholism (occurs at Dr, internet & school level)
- IATROGENESIS - medical treatment isn’t always good due to: misdiagnosis, cascade iatrogenesis (infection from treatment which leads to side effects), structural iatrogenesis (can’t self-care so rely on hospitals)
WHY HEALTH IS A SOCIAL CONSTRUCT
- not everyone experiences symptoms in same way
- dif. societies have dif. diagnosis & treatment models
UTILITARIANISM
- tell truth and only lie if lying has better outcome than truth
- right or wrong depends on outcome e.g. railroad
- act utilitarianism (each act evaluated separately)
- rule utilitarianism (never lie)
PROS OF UTILITARIANISM
flexible, pretty moral & intuitive
CONS OF UTILITARIANISM
- hard to predict consequence (if outcome is bad, did you make a bad decision & is it on you)
- people have no actual value in system (one person expendable in interests of many)
- one person seems to be considered more valuable than other (dr>builder)
DEONTOLOGICAL ETHICS
- judges right or wrong based on moral code of rules rather than on the consequence
- tell truth as it is your duty
PROS OF DEONTOLOGICAL
- places value on intention (if you made decision thinking it is right and you failed, you still tried to help)
- accords human being moral worth (people aren’t expendable)
CONS OF DEONTOLOGICAL
- always cases that don’t fit the rules
- always acts that cause suffering in defence of a principle
VIRTUE ETHICS
- having right values & also practical wisdom (learning from a tutor e.g. telling truth cos that is what a good person would do)
PROS OF VIRTUE ETHICS
- proves to be good as we do actually use what our mentors teach us
- understands that we are just developing
CONS OF VIRTUE ETHICS
- doesn’t help with decision making (who is actually a good role model or are you just picking role model)
- takes time to develop virtue, encourages perfectionism (compared to fictional perfect Dr)
FRANCIS REPORT
- Stafford hospital had lots of excess deaths due to misled meds, staff verbal abuse, patients unwashed, poor hygiene, staff showing lack of compassion
- mismanagement (understaffed, junior Drs left alone managing)
- ethical failure to learn from mistakes & provide good care & personal care
- emotional needs unmet (poor immune function, impaired wound healing)
- led to duty of candour (be honest with patients about mistakes that happened in your care & offer good remedy & explain consequences)
MEDICALISED DEATH
medicalised intervention (e.g. breathing tube) may interrupt ‘natural’ death & be distressing so HCP & family must negotiate on what is most beneficial
PALLIATIVE CARE
- built on acceptance of being ate end of life & dying person has autonomy so aims to improve quality of life over quantity (death ideally at home or hospice)
- people from BAME access palliative services less & less likely to do advanced care planning (awareness? different illnesses?)
CULTURAL ISSUES FOR HCP
- need interpreters, understanding particular needs/wishes
- hospice staffed by white christians
ISSUES OF CULTURING STAFF
- HCP may feel overwhelmed
- training may be general & unhelpful (so ask individually)
FUNERAL FUNCTION & IMPORTANCE
- function - respectfully getting rid of body, chance to say goodbye, living have respected the deceased wish
- important due to beliefs, tradition, tradition is comforting, social event, important role for deceased’s family
MUSLIM FUNERAL
muslims only buried, funeral straight after, Quran read after wash of body, body taken to mosque pre-burial
SIKH FUNERAL
instant cremation, initially coffin goes to family home for last respects then to Gurdwara for service
UNCONSCIOUS BIAS
e.g. test dummies are male body size so sub-consciously biased to men
ESSENTIAL QUALITIES OF A GOOD COMMUNICATOR
competent, kind, refective, reassuringly confident
HELMANN FOLK CONSULTATION MODEL
approaches consultation completely from patient perspective (what has happened)
NEIGHBOUR CONSULTATION MODEL
connecting, summarising treatment to patient, getting approval, checking treatment is definitely best, am i in shape for next patient
CALGARY-CAMBRIDGE CONSULTATION
building relationship (computer/patient notes don’t interfere with consultation) & showing empathy & compassion
PENDLETON ET AL CONSULTATION MODEL
involve patient in management decisions & use time & resources well & establish relationship
LIST OF INFO PATIENTS WANT TO KNOW ABOUT MEDS
side effects, what it does, Do’s & don’ts, how to take it
CONCERNS ABOUT MEDS THAT STOP PPL TAKING IT
may have forgot what Dr said, scary side effects, safe keeping of med (Expiry date, temp, time)
DOCTOR BASED
- Dr is lead, only physical aspects, no chance for patient to express concerns or mental belief
- encourages trust in Dr but liable to mistake as not taking patient whole report
PATIENT CENTRED
- mutuality (dr & patient both participate), open questions, patients encouraged to have a say
- most valuable when patient worried or for building trust & respect
1978 BAROFSKY DEFINITION OF FUNCTIONS OF SELF CARE
restorative (alleviate illness), reactive (alleviate symptoms), preventative (prevent disease), regulatory (regulate body processes)
ORTHOREXIA
when healthy eating becomes an obsession
CONS OF HOME TESTING KITS
- could get wrong result due to error or not understanding way kit works (unnecessarily paranoid)
- wrong diagnosis can encourage you to buy wrong pill (dangerous)
PROS OF HOME TESTING
saves time, not everyone has to know about your condition (GP everyone has to write notes)
MASTER STATUS
the primary identifying characteristic of a patient (disease they name first - so find most important)
ACUTE ILLNESS
ongoing, cure expected, QOL dependent on HCP care, HCP has better knowledge on the illness, needs compliance
CHRONIC ILLNESS
episodic, incurable, QOL dependent on patient self-care, patient has better knowledge on the illness, compliance & self-reliance expected
GMC STANCE ON CONFIDENTIALITY
patients can expect their personal info will be held (key for relationship AS health care is sensitive e.g. alcohol addiction)
DEONTOLOGY VIEW OF CONFIDENTIALITY
need duty of confidentiality as rationally derived duty to do something
UTILITARIAN VIEW OF CONFIDENTIALITY
real utilitarians say it must be held as the consequences are more severe but act utilitarians judge each act differently
VIRTUE ETHICIST VIEW ON CONFIDENTIALITY
would a good Dr breach confidentiality? NO, so be a good Dr & keep it
WHAT ISN’T CONFIDENTIAL
‘hunter vs man’ says everything is confidential but we now know it is only illegal if there is unauthorised use of confidential info
WHEN TO BREACH CONFIDENTIALITY WITH REQUEST
research, publication, teaching, third party requests (e.g. insurance)
WHEN TO BREACH CONFIDENTIALITY WITHOUT REQUEST
- when disclosure needed by law (e.g. specific road accident and you need details of meds, or if infectious disease
- when disclosure in public interest (breaking > keeping confidentiality e.g. disease or crime (but still tell patient anyway
1990 W VS EDGELL
psychiatrist assesses prisoner
CALDICOTT GUARDIAN
person in the trust responsible for safeguarding patient data & justify purpose of use (need-to-know basis) & only use minimum required
2018 DATA PROTECTION ACT
can refuse patient right to access if disclosing causes harm or unsure of identity as data must be fair, lawful, up to date, protected of damage
PRINCIPALISM
just the 4 pillars
CLINICAL ICEBERG
as Drs you only see tip of iceberg as many people do home remedies or just don’t come in
Zolas triggers
interference with relationships, activity, occurence of interpersonal crisis (e.g. grandma die stresses you out makes you go GP), temporalising (i’ll do next week), sanctioning
COMPLIANCE VS ADHERANCE
- compliance is doing what Dr said
- adherance is doing what Dr said but also discussing it before with them (patient input)
- non-adherance (intentional (know patient is confused but ignore it) or unintentional e.g. Dr misunderstood patient)
MIDDLE CLASS HEALTHISM
e.g. eating avocado toast & these things encourage self care
FACTORS AFFECTING QUALITY OF DECISIONS
competency, pressure, deceived (info hidden from you)
AUTONOMY
- ability to live according to our own values & beliefs
- limiting autonomy impinges someone’s sense of self & leads to emotional reaction
- when autonomy is lost, all focus is put on beneficence
AUTONOMY VS BENEFICENCE
Dr’s used to favour beneficence over autonomy as believed Dr knows more but we now know Dr can’t make decision as they dont know more about the patient they just know more about medicine
SIDAWAY VS BETHLEM ROYAL HOSPITAL 1985
- Dr operated on patient without full consent as didn’t inform of all risks & is guilty of crime (unless emergency)
- led to need to inform patient of alternatives & also consequences of the procedure
MONTGOMERY VS LANKASHIRE 2015
- Dr didn’t tell patient about risk of shoulder dystocia & baby suffered oxygen deprivation & supreme court ruled Dr has duty to inform patient of risks & alternatives
- led to question of what is material risk (a normal person in this patient position would add significance to the risk or if the Dr just knows that this patient would)
IS CONSENT ALWAYS VALID
- consent is only valid if our decision-making rules apply (voluntary, informed, competent)
- Dr must ensure consent is valid
WHEN CAN YOU BREAK CONSENT
- emergency treatment of unconscious or otherwise incapacitated patient
- urgent mental health treatment under mental health act
CAPACITY
- ability of an individual to choose how to live their life in accordance with their own values
- losing capacity -> losing autonomy
COMPONENTS OF CAPACITY
- understanding the info (only relevant info so keep bar low, don’t assume prior knowledge)
- recall the info (retain info only for long enough to make decision)
- weigh up decision (see pros & cons & relate them to decide)
- communicate the decision (facilitate it by giving all necessary tools e.g. translators, time, support)
ARSKAYA VS UKRAINE CASE 2013
patient refused treatment & Drs ignored clear symptoms of mental disorder but court ruled they should have assessed capacity
TWO-STAGE TEST
- clear impairment in function of a person’s mind or brain?
- is impairment sufficient that person lacks capacity to make THIS PARTICULAR decision (understand, recall, weigh up, communicate)
DYNAMIC CAPACITY
capacity is dynamic as only about making that particular decision at that particular time
NOT RIGHT TO DEMAND
capacity is patient right to decide between treatments not choose their own
MENTAL CAPACITY ACT 2005
- 16 years old +
- Capacity is always presumed, support of individuals to make decision, must honour decisions even if they seem unwise, patient’s best interest, less restrictive option (if no capacity, choose option that limits least number of choices in future)
IF PATIENT HAS NO CAPACITY (8)
- can it wait
- what is best for average patient (common clinical option)
- what is best for this specific person (e.g. any risks patient wouldn’t take like amputation)
- can you get more info (anyone who knows better)
- advanced statements (info patient feels is relevant to future if they lose capacity)
- advanced decision (advanced decision to refuse certain treatment (signed & in writing))
- anyone else who has right to decide? (look for lasting power of attorney (one stated person has power to make decision if patient has lost capacity)
- if total lack of capacity get a MCA (decides if patient is >16 & lacks capacity & has no relatives or friends)
GILLICK COMPETENCE
- <16 can decide if sufficient understanding & intelligence to understand what is involved, purpose, nature, risks, chance of success
- if no gillick ask parent consent
- if gillick competent & child refuses treatment, parents can overrule it
FRASER GUIDELINES
- competence in case of U16 seeking contraceptive or termination of pregnancy (give if mature & understanding)
- can’t persuade U16 to tell parents
- his/her mental health could suffer if not given the treatment
DIFFERING VIEWS ON CONFIDENTIALITY
D - you have a duty to maintain confidentiality
U - outcome is always better if confidential
V - good Dr would be confidential
