PPS REVISION Flashcards
What is a social construct
the understanding that everyday knowledge is creativity produced by individual and is directed towards practical problems.
Ethnicity is based on two main things ethnic group and ethnic origin what is the difference
a. ) Ethnic group- based on an individual conception of social group membership and personal identify
b. ) Ethnic origin- an allocated definition based on common ancestry or place of origin
what are the 4 guidelines that must in order to include race as a factor in research.
- to define ‘race and ethnicity’ in the context of the requirement of the research study.
- to explain how these categories relate to the research hypothesis
- To describe how participants are assigned to research categories
- To describe the limitations of the study with respect to the populations to which research findings can be generalised (reason why scientists may ignore social construct in their research)
What is meant by the professional duty of candour?
Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress. apologise to the patient (or, where appropriate, the patient’s advocate, carer or family)
what is needed in order to prove negligence in a civil suit.
In order to prove negligence in a civil suit the plaintiff must prove three things (on the balance of probabilities):
1. The doctor had a duty of care (easy to establish)
- The duty of care was breached (harder to establish)
- a doctor is not guilty of negligence “if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art”
- a doctor is not guilty of negligence if his actions have a “logical basis” - The breach of the duty of care caused harm (hard to establish)
• Injuries/deaths often caused by number of factors
A night watchman attended A+E with abdominal pain. The doctor on-call refused to see the patient and told the nurse to discharge him. The patient died soon afterwards. It is later discovered that the night watchman had accidentally been poisoned with arsenic. The patient’s wife sued the doctor. Did she win her case?
• Did the doctor have a duty of care? YES!
• Did the doctor breach his duty? YES!
• Did the doctor cause patient’s death? NO
• the patient would have died in any case
So, did the patient’s wife win her case? NO as failure to prove causation!
A young man presents to his GP with a lump in his left testicle. The GP diagnoses a benign lump. 12 months later the patient presents again to his GP and this time a malignancy is diagnosed. The patient is informed that his chances of survival have now been reduced from ~40% to ~20% due to the late diagnosis.
Is there negligence in a case like this?
In similar case the claimant closed his case as even if he was diagnosed things probably wouldn’t have changed. Have to be able to prove that had the defendant not acted negligently they would have been more likely that not to not have suffered the loss.
what is the limitation period when it comes to making claims about medical negligence.
- limitation period: actions for negligence should be brought within three years of claimant discovering damage
- courts have the discretion to extend limitation period
- In case of neonates, period does not start until patient reaches maturity (18)- actions can be brought until child is 21
If you sign a prescription on the advice of another and it goes wrong who is responsible
If you sign a prescription (even on the advice of another) YOU are legally responsible.
Is lack of expertise and lack of experience taken into consideration in legal settings
lack of expertise IS taken into account when determining negligence however doctors do have a duty to refer.
lack of experience is NOT taken into account.
litigation can lead to defensive medicine. what is litigation and what is defensive medicine?
Litigation- the process of taking legal action-
Defensive medicine “the practice of performing tests as a safeguard against possible malpractice liability rather than to ensure the health of patients” - waste of resources
Can existing phycological theories of health behaviour adequately explain harmful health behaviours?
Or
What can psychological theories tell us about why individuals engage in harmful and risky health behaviours?
- The health belief model
based on how much of treat you think something is, the benefits you will get and whether you think you can change or not will depend on whether there is changed behaviour.
A-identifies important barriers to change
D- treat does not predict behaviour change- smoking, drinking, drugs. Leaves out emotion, habit, social norms…
- The theory of planned behaviour
Intention is said to be a result of a process that takes account of:
-attitudes
-Subjective norms
-Perceived behaviour control
and based on your intention you will choose to change your behaviour.
A-intentions predict some behaviour/ highlights social norms
D– Most of the time intentions do not predict behaviour. Past behaviour is often the best predictor of behaviour. Environmental influences. Habits.
- Transtheoretical Model
Stages:
• Pre-contemplation – no change contemplated
• Contemplation – desire to change within 6 months
• Preparation – intend to change in near future
• Action – behaviour is changed
• Maintenance
• Relapse
A- - Broad and has identified many useful processes involved in behaviour change
D- this process does not happen in all changed behaviours. Does not factor in spontaneous change.
- Cognitive dissonance theory
This is a theory that when two beliefs/ thoughts. contradict themselves this causes as negative feeling and so people will attempt to solve this. This is done by either changing your first or second belief/ thought.
e..g. smoking can kill and cause diseases, I smoke. - The COM-B mode (newest)
capability, motivation and opportunity needed for changed behaviour. (remember it as what is needed to prove someone is guilty.
problems with them all:
Most theories implicitly assume a high degree of rationality in human behaviour
new models will need to include concepts of:
identity, impulse, momentary priorities, accidents, spontaneous/chaotic change.
what is the difference between physical activity and exercise?
Physical activity: Any bodily movement produced by skeletal muscles that results in energy expenditure e.g. vacuuming, bringing in shopping
Exercise: activity requiring physical effort, carried out to sustain or improve health and fitness e.g running or football
what is the adult and child recommendation for exercise?
Adults should engage in at least __150____mins of moderate intensity activity every week
Or alternatively they should do __75____minutes of vigorous activity across the week.
What about children? How much physical activity should they do? _____60 _____Minutes per day
Name 2 unmodifiable predictors of physical inactivity.
- Being male – stronger sports culture
- Being younger – as responsibilities reduce PA
- Genetics
H. Name 2 modifiable predictors of physical inactivity.
- Higher socio-economic status- safer environment
2. barriers to PA – lack of time, don’t enjoy exercise
I. Which theory of health behaviour includes intention and motivation?
Theory of planned behaviour
describe examples of physical activity interventions
London bus study –
Traced the hearth attack rates of bus drivers and conductors
- The bus drivers sat for most of their shift.
- The conductors climbed about 600 steps each day
- Conductors had half of heart attacks over the bus drivers
Susan mayor 2018- Study finds physical activity reduces the risk of depression at any age
Ratey 2008 – PA improves cognitive ability. In a high school with early morning exercise program there was improved literacy, algebra and reading sores.
• Discuss common health behaviour theories which focus on changing behaviour to increase physical activity,
- theory of planned behaviour
3 things determine this intention:
- Attitude: the feeling someone had towards something
- subjective norm: The normal attitude (around us toward the behaviour
- perceived behavioural control: how much control we think we have over whether we can or want to undergo the activity
But intention doesn’t always lead to activity.
- Habit formation
- Context dependent repetition leads to behaviour change.
- But how long does it take to forma habit- average 66 days but range is from 18-356 days.
- COM-B model- motivation, opportunity, capability
- The role of genetics
• Critically analyse different ethical principles that support resource allocation decisions.
You have one liver who do you give it to and why (apply these ideas)
Bob, 2, Baby
Congenital liver disease.
Prognosis with new liver – fairly good
Christos, 19, student
Cirrhosis secondary to congenital biliary atresia.
Prognosis with new liver - fairly poor.
Douglas, 75 , company chairman
Company provides 200 local jobs. Viral hepatitis contracted during voluntary work in Africa. Prognosis with new liver – good
Barbara, 30 , single mother
Chronic liver failure since mid 20’s. Paracetamol self-poisoning, alcohol abuse. Prognosis with new liver - very good
The veil of ignorance
- This a device to facilitate thought about what a ‘just’ system would look like
- Argues that we should think of ourselves behind the ‘veil of ignorance’ where we know nothing about our status, ability, ethnicity, wealth etc.
- Then we would create the fairest society just in case we end up being the weakest, poorest, least intelligent etc.
- Free market
- Where everyone has ownership of their own money and instead of getting the government involved you spend your money when you want and where you want. The government should only be involved in making sure trades are fair and people stick to their word.
- Disadvantages: Firstly, those who are particularly disadvantaged will have a big problem in accessing resources. Secondly, even though the government would make sure exchanges are looked over however it is a matter of luck how you would end up as a result of them. Also, some people are just more skilled than others and it will end up disadvantaged. - Lottery
- Everyone has an equal opportunity
- But does not take into consideration prognosis or outcome or age or if the problem is self- inflicted etc. - Need (allocation on the basis need)
- Strongly used in the NHS but then you need to define need appropriately ( is low self- worth a need for surgery etc.)
- How do you compare need? How does my need for preventative health care measures compare to someone else’s need for stage 3 cancer treatment. - Consequentialism
- The outcome outweighs the means and looks at the consequence of the allocation
- For example, if I give this person this treatment how much improvement in quality of life over how many years this going to be gained for. (QALY search it.)
- However, ageist. - Personal responsibility
- you made the mess; you clean it up
- Self-inflicting diseases e.g. from smoking
- The NHS does not work by this - Social worth – who is ‘worth’ more?
- Who has a larger contribution to society for example a mother of 4 who is a doctor may be ‘worth more’ than a man on benefits.
- Can lead to discrimination.
- Or for example someone who is a key worker should have more of a right to PPE. - The democratic way (democracy)
- Idea is that how resources are allocated should be decided on the basis of democracy so what the majority of the people want. - Pluralism
- Considering all of the different values and try and bring them together to make a decision (all above)
- But how much weighting do you give to each method also some may argue that these different methods cannot be compared as they are completely different. E.g. you would compare apples and pears.
(a) In outline, describe the differences in health outcomes that currently exist between social classes in the U.K
Educational attainment: Strongly linked with health behaviours and outcomes. Low attainment may impact on many outcomes in later life including, quality of work, future earnings, involvement in crime, and high rates of morbidity.
Employment: One of the most important determinants of physical and mental health; The effect of unemployment does not just affect individuals. Children growing up in workless households are almost twice as likely to fail at all stages of education compared with children growing up in working families.
Living standards/income: There is a strong association between income and health, with many health outcomes improving incrementally as income rises.
A parent’s income may influence a child’s early development and educational opportunities, which in turn can affect a child’s employment opportunities and their income.
Relative health risk is primarily associated with an individual’s socioeconomic class position. (E.G if you come from a lower class more likely to smoke, live in a part of London with high levels of pollution, get a poor education or be involved in crime)
poor nutrition
(b) Identify and briefly describe two social explanations that account for the contemporary trend in health inequalities.
Low attainment in school may impact on many outcomes in later life including, quality of work, future earnings, involvement in crime, and high rates of morbidity.
A parent’s income may influence a child’s early development and educational opportunities, which in turn can affect a child’s employment opportunities and their income.
If you have more money and higher class more likely to be able to afford to live in a place with low levels of pollution.
what is the difference between health inequality and health inequity.
Health inequality: This refers to differential health outcomes (e.g. mortality and morbidity rates) as a result of social and economic inequalities. for example poorer people more likely to have COPD
Health inequity; This is an unequal distribution of resources between different population groups which results in different levels of access to health services.
One example would be access to health services based on income in predominantly market-based health care systems i.e the USA. so very much about distribution of resources.
how has life expectancy changed over the years?
For men and women of all social classes, life expectancy has increased, but the gap in life years between classes has not narrowed in fact they have widened.
Social inequalities have widened as a consequence of greater gains in life expectancy in the least deprived populations
