Principles and Philosophy

Question 1

3 goals of Evidence Infromed Practice

Answer 1

the best care
based on the best available evidence
for the good of the patient

Question 2

4 Pillars of EIP

Answer 2

• critical mass of high quality - research evidence trumps authority or experience
• Clinical research can help predict the probability of a particular clinical outcome and the average response
• research focused on patient centered outcomes trumps bench science or research on biological changes in patience
• research evidence must be interpreted thru the lens of experience and integrated with patient preference

Question 3

5 A’s of EIP

Answer 3

Ask
Acquire/Access
Appraise
Apply
Self Asses

Question 4

Hippocrates

Answer 4

4th centruy BC
father of medicine
separted religion from medicine
believed medicine was a calling and treated all people equal
not to differentiate by class or riches

Question 5

Galen

Answer 5

1st to document details of his surgeries and treatments

forwarded the humours theory of hippocrates (black bile, yellow bile, blood and phlegm)

Question 6

Dark ages of Medicine

Answer 6

same time as the fall of the Roman Empire

• self treatment was advocated with books explaining process
• religion began to return to healing as the driving force resulting in exhaltation of saints and Miracle Healers

Question 7

St Rouche

Answer 7

plague

Question 8

St Dymphna

Answer 8

mental illness

Question 9

Phillip von Hohenheim

Answer 9

father of modern toxicology

Question 10

Andreas Versalius

Answer 10

1st to significantly counter and disagree with Galens treatises
authored the Fabric of the Human Body…first major anatomy textbook

Question 11

The Barber Pole

Answer 11

red is blood (letting) white is bandages, and the blue is for veins

Question 12

William Hervey

Answer 12

accurately described blood flow and the hearts role

brought an end to the 4 humours theory in the 1600’s

Question 13

Jenner

Answer 13

created small pox vaccine from cow pox, this was the 1st vaccine

Question 14

William Thomas Green Morton

Answer 14

first to use Ester as an anesthetic

Question 15

Anestetics

Answer 15

credited with making surgery a survivable experience

heralded the age of surgery as a modern concept

Question 16

James Lind

Answer 16

nutritional cures (Vitamin C for scurvy)

Question 17

Rene Laennec

Answer 17

created the stethescope

Question 18

Robert Koch

Answer 18

discovered anthrax and Tuberculosis microorganisms

Koch’s postulate

Question 19

Kochs Postulate

Answer 19

• the causative agent must be present in every case of the disease and must not be present in healthy animals
• the pathagen must be isolated from the diseased host animal and must be grown in pure culture
• the same disease must be produced when microbes from the pure culture are inoculated into healthy, susceptible animals
• the same pathagen must be recoverable once again from this artificially infected animal and must be able to be grown in pure culture

Question 20

Louis Pasteur

Answer 20

began to articulate the germ theory

Question 21

Wilhelm Conrad Roentgen

Answer 21

used Crooke’s tube to create the 1st x ray

Question 22

Gerhard Domagk

Answer 22

inventor of sulfa drugs, the first anitbiotics

followed shortly after was the discovery of pnnicillin

Question 23

Health Insurrance

Answer 23

financing relies on resource pooling
-process of collecting small amounts of money from many to redisribute those resources to the sick populations to cover costs of their illnesses

Question 24

“The Bet” of health insurrance (8)

Answer 24

individuals gett ill at a reasonably predictable rate
the ilnneses populations suffer can be reasonably predicted
rational customers do not want to get sick
resultant expenses can be predicted
cost administering can be predicted
the profit of the system can be estimated
the revenue needed to offset the cost, related to the support structure can be prosectively calculated
revenue from all can be pooled to cover costs of the few

Question 25

Cost of Health Care

Answer 25

$2,809 Billion per year
$8,952 per capita
17.9% of GDP

Question 26

The percentage of US population not insured at all

Answer 26

15.4%

Question 27

Reasons for not being insured

Answer 27

Cost of insurance and recently loosing employment

Question 28

Year of first group health insurance plan

Answer 28

1847

Question 29

Year of Incorperation of Blue Cross and Blue Shield

Answer 29

1932

Question 30

Unions in the 40s and 50s

Answer 30

to drive employment increase unions used health insurance as “fringe benefits”

Question 31

Major Governemtn insurance Plans

Answer 31

Medicare
Medicaid
Tricare
Veterans Administration

Question 32

Primary Elements of Health Care Financing

Answer 32

Cost
Quality
Access

Question 33

Cost (managed care)

Answer 33

compensation lower; all products and technologies purchased at substantial discount due to volume and purchase power

Question 34

Quality (managed care)

Answer 34

standardized practices using evidence and procedural requirements augmented with substantial peer and case oversight, review and control

Question 35

Access (managed care)

Answer 35

patients and physicians practice in pre-established locations and facilities that have control over technology, equipment and theraputic options

Question 36

Types of Managed Care Structures

Answer 36

Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point-of-Service Organization (POS)

Question 37

Consequences of Managed Care

Answer 37

Patient autonomy is reduced- care is provided through a pre-chosen network or organization
Physician Autonomy is reduced - strict case management, centralized review of the appropriateness of provider practices
Selective Contracting - payers negotiate prices and contract selectively with local providers
Patients experience “Gatekeepers” - must see primary physician who need to prescribe any specialty services
Provider compensation is controlled and often reduced

Question 38

Potential Problems of Managed Care

Answer 38

Dumping
Creaming
Skimping
Lower Quality

Question 39

Medicare

Answer 39

established in 1965

to ensure that insurance was available to retired folks