Ptsr Flashcards
What is ethics
Moral principles that govern a persons behaviour
What is law
A system of rules that are created and enforced through social or governmental institutions which regulate behaviours.
3 ethical duties of care
Protect patient life and health
Respect autonomy
Act justly and fairly
Therapeutic relationship
Engagement between patient and dentist which has a beneficial impact on patient
Gd principle 5
Have a clear and effective complaints procedure
Outline complaints procedure (RDRD)
Resect patients right to complain
Deal with the complaint in a calm and constructive manner
Resolve the complaint by apologising and offering a practical solution
Dentist should have insurance and indemnity (financial protection).
Case law
Law that evolves with new decisions neing made by judges in court
Statute law
New law that is issues by governement
What happened in case of RvBrown 1989
Deception of NHS as dentist was claiming fees for work he had not done
Christie v Somerset Health Authority 1991
She suffered from permanent residual numbness following wisdom tooth extraction = Neglicence case as harm caused to patient
3 conditions for neglicence proving
Dentist had a duty of care to patient
Harm was resulted to patient
Dentist caused the harm
Montgomery v Lanarkshire 2015
Case law passed that patients must be informed of risk if treatment and reasonable alternatives - links to GDC standard principle 3 - valid consent
Gdc role
Provide a set of standards that must be abided
Protect patients abd regulate the dental team
- registration of dentists
- education and continual professional development
- discipline of health and professional misconduct
Carmichael vs GDC 1990
Professional misconduct leading to deregistratioj from GDC
Helsinki declaration 1960
Any research involving humans must take consent and be informed and voluntary and benefit should outweigh the harm.
Bolam test
Assesses medical negligence and used to base it on the reasonable dentist - which meant that it depended on whether another clinician wpuld testify in doing the same thing as what the doctor/dentist in the particular case did
New bolam test
Moves towards reasonable patient.. clinician must make patient aware if material risks so they must consider whether patient or any reasonable and prudent patient would attach significance to the risk
Appleton vs Garret 1997
Informed consent
Patients not given enough information on treatment so sued their dentist due to gross over treatment
What is battery
Unlawful touching of a person without their consent
Doctrine of necessity
If patient is unconscious the doctor must act in their best interest regardless of relatives opunujn
Paternalism
Restricting freedom and responsibility of patients, as the dentist acts as a parent and makes the decisions for the patient on the basis of what they believe is in the best interest of the patient.
Remember golden rule
Useful in every topic to mention
Maintaining confidentiality
Secure note storage
Privacy in the clinic
Dont discuss patient information when speaking on the phone in clinic
Privacy on social media
Verbally reassure patient about confidentiality
All staff on premises should be trained on the policies on maintaining confidentiality
Criteria for medical records
Up to date
Complete
Accurate
Tarasoff case 1976
Confidentiality- a case law that now states that confidentiality can be breached if there’s potential of harm to someone else eg tarasoff girl ended up killed.
3 stages pf making a competent decision on treatment
Take in and retain the information
Believe it
Weigh the info in terms of risks and needs
Re C (1994)
Patient with schizophrenia (delusions) refused amputation of gangrene in leg
F v West Berkshire 1990
36 year old woman had mental disability, the clinician acted in her best interest and a sterilisation occured without her consent, this was legal since she was incompetent.
Mental capacity act 2005
Appearance and behaviour shod not determine competence + unwise decisions + mental disability/learning difficulty
Capacity is assimed unless groubds for believing otherwise
Gillick case 1985
Case law on childrens competence - under 16 year olds - consent can be taken as long as they fit the competence criteria. If not then parent can give it.
Nhs plan for nhs dental services 2000
1) rewarding dentidts for their commitmentbto the nhs
2) more funding to dental practices to mskr services more accessible
3) dental access centres for ppl not registered with a dentist
4) increase availability of information about treatment and oral health advice
Thorndikes law of effect (1898)
The result of a behaviour influences the rate of occurence of the behaviour. Positive result = increase in behaviour frequency
Influence of knowledge on health behaviour
Has a short term effect as seen in a Brazilian study on school children (mayer et al 2003), after 5 years their dental health knowledge was greater in the intervention group however there was no longer a correlation with behaviour.
3 stages of the learning theory (abc)
Antecedants
Behaviour
Consequence
Antecedant?
Environmental stimuli associated with the behaviour. Increase it will increase the behaviour
Describe the study by kegels et al 1978)
Positive reinforcement: Children given dental hygiene talk, those receiving rewards for compliance in the following 20 weeks had greater compliance %, compared to those who weren’t rewarded.
Expectancy-value theory
The likelihood of a behaviour in an individual depends on their expectancy of the outcome and how much they value that outcome.
Whats the citation of health beliefs model
Rosentock 1966
Results in study by steele et al 1996 on dental attendance.
67% - no need to attend
32.4% fear of treatment
30% too expensive
List the 3 theories for behaviour occurence
1) expectancy - value theory
2) health beliefs model
3) theory of planned behaviour (social norms about the behaviour affect the likelihood of it occurring)
Primary appraisal
Perception of severity of a situation in terms of its demands
Secondary appraisal
Perception of whether the individual has adequate coping resources to tackle the demamds
Models of stress
Physiological model Adaptation model (ARE) Transactional model (1/2 appraisal)
Marucha 1996 (stress and physiological changes)
Reduced mucosal healing when students had punch biopsy during exam stress compared to summer vacation
Sutton 1965 - stress effects
Caries group attending dental practice - 97% reported stress compared to 21% in non caries group
This may have been caused by behavioural changes:
What is stress
Condition caused when an individual perceives an imbalance between demands of a situation and their coping resources.
Shaping behaviour
Complex behaviours learnt in smaller steps via rewarding behaviours that are similar to the complex behaviour.
Fear definition
Painful emotion caused by danger/apprehension of danger
Anxiety ?
State of unease caused by fear and apprehension
Wat is phobia
Fear that cannot be explained, and is out of proportion with the demands of the situation
Adult dental health survey 1998 (surgery carried out every 10 years)
45% of adults always anxious about dental treatment
What is the case law for Uk Professional standard for consent
Bolam vs friern HMC (1957)
What are the types of risks
Significant risks affecting judgement of prudent reasonable patient.
Material risks which are more specific and subjective to the patient - the particular patient at hand may attach significance to it hence needs to be disclosed.
Interpreter
An individual who interprets for the patient and health care professional so they can communicate and understand each other via a common language
Advocate
Interprets for them plus supports the patient by ensuring they have all the knowledge and understanding and confidence to make an informed decision, and may also refer them to other organisations that can help them.
Adult ego state describe
Rational and logical thinkers and not controlling
Describe Wallstons Locus of control
Believing that the change in behaviour will actually have a positive effect eg reduced sugar freq reduces caries.
Objectives for an appointment
Introduction- welcome n make patient feel at ease.
Accurate medical examination and history
Enquiring about patients expectations of the appointment (what is important to them n wat do they want)
Clear explanations of problems or treatment options - all information relevant disclosed
Check their understanding - be open to questions n summarise after every smalk chunk of info.
Shared decision making in treatment plan of action - take informed, valid, voluntary consent
Adult to adult relationship goal
Improving patient recall
Reduce anxiety
Check current knowlefge/ understanding
Dont use jargon
Ensure info is relevsnt and is the appropriate time to talk
List edamples of verbal communication
Open/closed questions Tone of voice - soothing for anxious patients, speed n pitch Avoid jargon Check patient understanding Empathetic responses
Non verbal
Listening - nod , smile, give cues eg “tell me more”
Eye contact, body language, facial expression
Level of seating
Show instruments - explaining of procedure
Show radiographs
Health definition
Complete physical mental and social wellbeing
Oral health
Having complwte and sound dentition with 32 straight teeth and no periodontal or soft tissue lesions, resulting in mental, social and physical health
Disease
Pathological condition diagnosed via signs and symptoms
Ilness
How a person feels when they are unwell and its effect on their daily life
Ill health
The effects of disease and illness on a person
Illness behaviour
The way that people monitor their bodies, they define and interpret their symptoms, take remedial action and utilise sources of help.
Limiting long term illness
Health problem/disability impacting a persons daily activities
Healthy life expectancy
How many years of life will be free pf long term limiting illness
Wat is the study that showed better effect of sebsory info being goven to parients to prep them (reduced stress)
Johnson and Leventhal 1974
Satisfaction with dentist correlating with attendance for preventive checkups (shane poor attendence)
Kent 1984
Describe study by mineka et al 1984
Social learning theory - monkeys gained fear from parents fear of snake
2 factor theory kf avoidance
Patiebt associates dentist (cs) with pain/fear (cr) hence avoid dentist and notice a remival of the pain n fear (negative reinforcement)
A study where one group of chikdren who were shown a film on restoratibe procedure on a chikd were more compliant during their appts than comtrol group - social learning
Melaned et al 1975
Indications of patient anxiety
Physiological - Hr n sweating
Behavioural - fidgeting, avoidance, facial expression
Patient telling you
Cognitively - patient poor ability to comprehend
Patients with higher anxiety levels had greater pain levels
Wardle 1982
Patients who were phobics had a greater reaction to painful stimuli- their pain threshold is reduced - wats the study :
Klepac 1982 (same yr as wardle)
Equality
Everyone is treated in the same manner irrespective of their differences, doesnt consider needs and requirements of ppl
Equity
Involves treating every individual according to his or her needs, it is fair and just, and considers needs of ppl.
Wat is inequality
Unjust and unfair differences in health determinants and outcomes within and between populations
Lower social class women have higher risk of mortality than upper class, in all ages
Langford and Johnson 2009
